Basic Information
| Provider Information | |||||||||
| NPI: | 1871537985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COWLBECK | ||||||||
| FirstName: | CARY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 7858 SHRADER RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232944222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042701305 | ||||||||
| FaxNumber: | 8042739294 | ||||||||
| Practice Location | |||||||||
| Address1: | 7858 SHRADER RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232944222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042701305 | ||||||||
| FaxNumber: | 8042739294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 0110001388 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 0900347 | 01 | VA | UNITED HEALTHCARE | OTHER | 540885859 | 01 | VA | C&O EMPLOYEE'S HEALTHCARE | OTHER | 540885859 | 01 | VA | COMPMANAGEMENT | OTHER | 540885859 | 01 | VA | FIRST HEALTH/CCN | OTHER | 540885859 | 01 | VA | CIGNA | OTHER | 285564 | 01 | VA | SOUTHERN HEALTH | OTHER | 32186 | 01 | VA | SH CARENET | OTHER | 540885859 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 008939969 | 05 | VA | MEDICAID | 540885859 | 01 | VA | PRIVATE HEALTHCARE SYSTEM | OTHER | 540885859 | 01 | VA | MULTIPLAN | OTHER | 970027195 | 01 | VA | RAILROAD MEDICARE | OTHER | 0536821 | 01 | VA | AETNA HMO | OTHER | 540885859 | 01 | VA | FOCUS | OTHER | 540885859 | 01 | VA | CORVEL | OTHER | 56197P | 01 | VA | OPTIMA HEALTH | OTHER | 68541 | 01 | VA | ANTHEM HEALTHKEEPERS | OTHER |