Provider Demographics
NPI:1033135405
Name:COWELL, BRENDA K (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:COWELL
Suffix:
Gender:F
Credentials:MD
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 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-355-5100
Mailing Address - Fax:704-342-4354
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:STE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5874
Practice Address - Country:US
Practice Address - Phone:704-355-5100
Practice Address - Fax:704-342-4354
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24754OtherBCBS
SCN35304Medicaid
SC11605440OtherBCBS
NC8924757Medicaid
NC24754OtherBCBS
SCN35304Medicaid
NC2171218FMedicare PIN
SC11605440OtherBCBS