Provider Demographics
NPI:1679679476
Name:FOWLER, MARTIN J JR (DO)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:FOWLER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 LAWN AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1560
Mailing Address - Country:US
Mailing Address - Phone:610-882-0284
Mailing Address - Fax:610-882-0218
Practice Address - Street 1:920 LAWN AVE
Practice Address - Street 2:STE 5
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1560
Practice Address - Country:US
Practice Address - Phone:215-257-4900
Practice Address - Fax:215-257-6681
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0118562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI08401Medicare UPIN
PA080307Medicare ID - Type Unspecified