Individual
MR. MICHAEL OLUWASOGO FOWOWE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1045 TAYLOR AVE STE 104, BALTIMORE, MD 21286-8315
(410) 296-0180
(410) 296-1587
Mailing address
2976 SIWANOY DR, EDGEWOOD, MD 21040-3435
(443) 414-3587
(410) 296-1687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0006689
MD
363AM0700X
Medical Physician Assistant
C0006689
MD
Other
Enumeration date
12/27/2017
Last updated
03/17/2018
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