Basic Information
| Provider Information | |||||||||
| NPI: | 1679679476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 LAWN AVE | ||||||||
| Address2: | STE 5 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108820284 | ||||||||
| FaxNumber: | 6108820218 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 LAWN AVE | ||||||||
| Address2: | STE 5 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152574900 | ||||||||
| FaxNumber: | 2152576681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | OS011856 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.