Provider Demographics
NPI:1871868240
Name:FOWLER, WILLIAM PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PATRICK
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 1:190 PRESIDENTIAL BLVD UNIT 510
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1159
Mailing Address - Country:US
Mailing Address - Phone:610-747-0378
Mailing Address - Fax:
Practice Address - Street 1:190 PRESIDENTIAL BLVD UNIT 510
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1159
Practice Address - Country:US
Practice Address - Phone:610-747-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028029E103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)