Provider Demographics
NPI:1083891212
Name:GEORGE D COWEN, MD PROFESSIONAL CORP
Entity Type:Organization
Organization Name:GEORGE D COWEN, MD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-582-6966
Mailing Address - Street 1:19845 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4055
Mailing Address - Country:US
Mailing Address - Phone:510-582-6966
Mailing Address - Fax:510-582-5632
Practice Address - Street 1:19845 LAKE CHABOT RD
Practice Address - Street 2:SUITE 211
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4055
Practice Address - Country:US
Practice Address - Phone:510-582-6966
Practice Address - Fax:510-582-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00185604OtherRAILROAD MEDICARE
CAA42046Medicare UPIN
CAP00185604OtherRAILROAD MEDICARE