MARTIN J FOWLER JR DO (Credential# 1002964) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2020. The license expiration date date is March 31, 2021. The license status is ACTIVE.
MARTIN J FOWLER JR DO is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.050269-DO. The credential type is physician/surgeon. The effective date is April 1, 2020. The expiration date is March 31, 2021. The business address is 1768 Business Center Dr., Reston, VA 20190. The current status is active.
| Licensee Name | MARTIN J FOWLER JR DO |
| Credential ID | 1002964 |
| Credential Number | 1.050269-DO |
| Credential Type | Physician/Surgeon |
| Credential SubCategory | DO |
| Business Address |
1768 Business Center Dr. Reston VA 20190 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2011-08-30 |
| Effective Date | 2020-04-01 |
| Expiration Date | 2021-03-31 |
| Refresh Date | 2020-02-19 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1033362 | CSP.0051392 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2011-09-15 | 2015-03-01 - 2017-02-28 | INACTIVE |
| Street Address | 1768 BUSINESS CENTER DR. |
| City | RESTON |
| State | VA |
| Zip Code | 20190 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Lakshmi Reddy Beeravolu | 1768 Business Center Dr., Reston, VA 20190 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Specialists On Call Inc. | 1768 Business Center Dr., Reston, VA 20190 | Securities - Exemptions | 2019-12-27 ~ |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Brigette Prinzivalli-rolfe | 1768 Business Center Drive, Reston, VA 20190 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Dani Korya | 1768 Business Center Road, Reston, VA 20190 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Michael Ng | 1768 Business Center Dr, Reston, VA 20190 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| 2020 Eastern Region Conference · American Society of Appraisers | 11107 Sunset Hills Rd #310, Reston, VA 20190 | Appraisal Continuing Education Course (aal) | 2020-03-11 ~ 2023-03-11 |
| Kamaldeen R. Saldin | 1768 Business Center Dr Ste 100, Reston, VA 20190 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Wcp Highlander Housing LLC | 11710 Bowman Green Dr, Reston, VA 20190 | Securities - Exemptions | 2020-04-01 ~ |
| Mohini Uttam Gurme | 1768 Business Center Dr., Suite 100, Reston, VA 20190 | Physician/surgeon | ~ |
| Eric B Sklar Md | 1768 Business Center Road, Ste 100, Reston, VA 20190 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Heather D Zdimal | 1701 Lake Shore Crest Dr., Reston, VA 20190 | Occupational Therapist | 2017-08-01 ~ 2019-07-31 |
| Riot Ventures Opportunity V-11 C1, LLC | 11911 Freedom Dr., Reston, VA 20190 | Securities - Exemptions | 2019-10-18 ~ |
| Find all Licenses in zip 20190 | |||
| City | RESTON |
| Zip Code | 20190 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + RESTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Fowler F White | 130 Doyle Road, Bantam, CT 06750 | Physician/surgeon | 2008-01-15 ~ 2009-03-31 |
| Michael S Fowler Md | Chh Cardiovascular Medicine, Torrington, CT 06790 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Sandra M Fowler | 1666 Callowhill St Apt 205, Philadelphia, PA 19130-4102 | Physician/surgeon | 2010-01-01 ~ 2010-12-31 |
| Chesney Price Fowler | Po Box 8322, Fleming Island, FL 32006-0010 | Physician/surgeon | ~ |
| Richard Kahrimanis Md | Fowler Nursing Center, Guilford, CT 06437 | Physician/surgeon | 2001-05-16 ~ 2002-05-31 |
| David J Martin | C/o O.s.m., Trumbull, CT 06611 | Physician/surgeon | 2019-12-01 ~ 2020-11-30 |
| Martin B. Leon | 1 Spector Rd, Woodbridge, CT 06525-1730 | Physician/surgeon | 1977-05-19 ~ 1982-05-31 |
| Martin Maimon | 701 5th Ave, Seattle, WA 98104 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
| Martin E Bur | 24 Warner Street, Belchertown, MA 01007 | Physician/surgeon | ~ |
| Martin Bauermeister | 17 Bay St, Wickford, RI 02852 | Physician/surgeon | 2000-02-15 ~ 2000-11-30 |
Please comment or provide details below to improve the information on MARTIN J FOWLER JR DO.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).