Provider Demographics
NPI:1639145147
Name:MCDOWELL, VESTA D (DPM)
Entity Type:Individual
Prefix:DR
First Name:VESTA
Middle Name:D
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-0624
Mailing Address - Country:US
Mailing Address - Phone:301-352-7756
Mailing Address - Fax:301-352-7725
Practice Address - Street 1:14300 GALLANT FOX LN STE 201
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4033
Practice Address - Country:US
Practice Address - Phone:301-352-7756
Practice Address - Fax:301-352-7725
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO415213ES0131X
MDP29611213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413635700Medicaid
DC010235300Medicaid
MD480007024OtherRR MEDICARE
MD480007024OtherRR MEDICARE
MD413635700Medicaid
DC1208510001Medicare NSC