Provider Demographics
NPI:1023002011
Name:COWAN, LARRY IRA (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:IRA
Last Name:COWAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-1821
Mailing Address - Country:US
Mailing Address - Phone:740-455-3304
Mailing Address - Fax:740-455-3686
Practice Address - Street 1:41 FOSTER DR
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-8010
Practice Address - Country:US
Practice Address - Phone:740-246-6361
Practice Address - Fax:740-246-4722
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.003340207QA0401X
OH34006965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0492024Medicaid
OH0803323Medicare PIN
080128599Medicare PIN
D89542Medicare UPIN