Basic Information
| Provider Information | |||||||||
| NPI: | 1386859783 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COWENS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | GERARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12116 STATE ROUTE 30 | ||||||||
| Address2: | MED EXPRESS URGENT CARE | ||||||||
| City: | NORTH HUNTINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248634362 | ||||||||
| FaxNumber: | 7248636024 | ||||||||
| Practice Location | |||||||||
| Address1: | 12116 STATE ROUTE 30 | ||||||||
| Address2: | MED EXPRESS URGENT CARE | ||||||||
| City: | NORTH HUNTINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248634362 | ||||||||
| FaxNumber: | 7248636024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 08/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35054169 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0739286 | 05 | OH | MEDICAID |