Provider Demographics
NPI:1740217611
Name:FOWLER, ERIC K (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:K
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 KISH RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-8943
Mailing Address - Country:US
Mailing Address - Phone:717-667-7720
Mailing Address - Fax:717-667-7249
Practice Address - Street 1:96 KISH RD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17084-8943
Practice Address - Country:US
Practice Address - Phone:717-667-7720
Practice Address - Fax:717-667-7249
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045246L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F24774Medicare UPIN
025448Medicare ID - Type Unspecified
PA001298665Medicaid