Provider Demographics
NPI:1912913856
Name:FOWLER, GERARD JOSEPH II (CO, BOCO, C PED)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:JOSEPH
Last Name:FOWLER
Suffix:II
Gender:M
Credentials:CO, BOCO, C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 PLEASANT ST
Mailing Address - Street 2:UNIT #3
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2553
Mailing Address - Country:US
Mailing Address - Phone:603-228-7159
Mailing Address - Fax:603-225-4265
Practice Address - Street 1:280 PLEASANT ST
Practice Address - Street 2:UNIT #3
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2553
Practice Address - Country:US
Practice Address - Phone:603-228-7159
Practice Address - Fax:603-225-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH4665514OtherAETNA
706167OtherHARVARD PILGRIM
NH30761501Medicaid
12Y002242NH01OtherANTHEM BLUE CROSS/BLUE SH
2264576OtherCIGNA
NH4665514OtherAETNA