Provider Demographics
NPI:1881805307
Name:FOWLER, TOLVERT E JR (MD)
Entity type:Individual
Prefix:DR
First Name:TOLVERT
Middle Name:E
Last Name:FOWLER
Suffix:JR
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:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1307
Mailing Address - Country:US
Mailing Address - Phone:540-901-7028
Mailing Address - Fax:540-901-2599
Practice Address - Street 1:3200 PEOPLES DR STE 210
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7633
Practice Address - Country:US
Practice Address - Phone:540-271-0911
Practice Address - Fax:877-758-4943
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202456207Q00000X
VA0101259536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA40994Medicaid
VA1881805307Medicaid
VA1881805307Medicare UPIN