1396780128 NPI number — DR. LAYSHIA T FOWLER D.P.M.

Table of content: DR. LAYSHIA T FOWLER D.P.M. (NPI 1396780128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396780128 NPI number — DR. LAYSHIA T FOWLER D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
LAYSHIA
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396780128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8502 16TH ST
Provider Second Line Business Mailing Address:
APT. 201
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20910-2967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-537-9278
Provider Business Mailing Address Fax Number:
301-585-0017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 WISCONSIN AVE NW
Provider Second Line Business Practice Location Address:
SUITE 522
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20016-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-966-0900
Provider Business Practice Location Address Fax Number:
202-966-0836
Provider Enumeration Date:
06/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  01384 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 213E00000X , with the licence number: PO1000049 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 213ES0103X , with the licence number: 0103300869 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 40811800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".