Provider Demographics
NPI:1841365061
Name:FOWLER, ANTHONY WAYNE (AUD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:WAYNE
Last Name:FOWLER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-646-9300
Mailing Address - Fax:717-737-4886
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-646-9300
Practice Address - Fax:717-646-9322
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT001146L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01726501OtherBLUE CROSS
PA001822982Medicaid
PA000219651OtherBLUE SHIELD
PA001822982Medicaid
PA039625Medicare UPIN