Basic Information
| Provider Information | |||||||||
| NPI: | 1790769917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COWEN | ||||||||
| FirstName: | RONALD | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820933 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152268800 | ||||||||
| FaxNumber: | 2152268819 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LEHIGH AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191322701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152268800 | ||||||||
| FaxNumber: | 2152268819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 10/04/2013 | ||||||||
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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 | 207Q00000X | 05002312L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 041709 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1001463 | 01 | PA | KEYSTONE MERCY HEALTH | OTHER | 2Y0377 | 01 | PA | HEALTH NET | OTHER | 000588517 | 05 | PA | MEDICAID | 0460696 | 01 | PA | AETNA HMO | OTHER | 544675 | 01 | PA | COVENTRY HEALTH AMERICA | OTHER | 5528438 | 01 | PA | AETNA PPO | OTHER | 698 | 01 | PA | BRAVO HEALTH | OTHER | CD4829 | 01 | PA | RAILROAD MEDICARE TPI GROUP | OTHER | PHP081 | 01 | PA | OXFORD | OTHER | 0057925000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 080114274 | 01 | PA | RAILROAD MEDICARE | OTHER | 597586 | 01 | PA | MEDICARE GROUP TPI | OTHER |