Provider Demographics
NPI:1952568156
Name:FOWLER, ROCKY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROCKY
Middle Name:WAYNE
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 1:3200 PEOPLES DR STE 210
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7633
Mailing Address - Country:US
Mailing Address - Phone:540-217-0911
Mailing Address - Fax:877-758-4943
Practice Address - Street 1:3200 PEOPLES DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7631
Practice Address - Country:US
Practice Address - Phone:540-217-0911
Practice Address - Fax:877-758-4943
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255140207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952568156Medicaid
LA05533Medicaid
LA05533Medicaid