Provider Demographics
NPI:1396780128
Name:FOWLER, LAYSHIA T (DPM)
Entity type:Individual
Prefix:DR
First Name:LAYSHIA
Middle Name:T
Last Name:FOWLER
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 1:8502 16TH ST
Mailing Address - Street 2:APT. 201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2967
Mailing Address - Country:US
Mailing Address - Phone:301-537-9278
Mailing Address - Fax:301-585-0017
Practice Address - Street 1:5100 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 522
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4119
Practice Address - Country:US
Practice Address - Phone:202-966-0900
Practice Address - Fax:202-966-0836
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01384213E00000X
DCPO1000049213E00000X
VA0103300869213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40811800Medicaid