Provider Demographics
NPI:1043215825
Name:COWEN, JEFFREY NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NATHAN
Last Name:COWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:915 TOLL HOUSE AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5930
Mailing Address - Country:US
Mailing Address - Phone:301-663-5790
Mailing Address - Fax:301-698-6259
Practice Address - Street 1:915 TOLL HOUSE AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5930
Practice Address - Country:US
Practice Address - Phone:301-663-5790
Practice Address - Fax:301-698-6259
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD30721207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD352891000Medicaid
D74501Medicare UPIN
MD017BMedicare ID - Type Unspecified