Provider Demographics
NPI:1760588263
Name:FOWLKES, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:FOWLKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4110 ASPEN HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2853
Mailing Address - Country:US
Mailing Address - Phone:301-438-5150
Mailing Address - Fax:301-460-0199
Practice Address - Street 1:67 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 4
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4863
Practice Address - Country:US
Practice Address - Phone:301-607-0444
Practice Address - Fax:301-831-4495
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00676852085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NPIOtherMEDICARE - COMMUNITY RADIOLOGY ASSOCIATES
NPIOtherMEDICARE - FREDERICK SITE
P0064443OtherRR MEDICARE
P00644447OtherRR MEDICARE
MD415144500Medicaid
NPIOtherMEDICARE - KORSOWER & PION RADIOLGOY
VANPIMedicaid