Provider Demographics
NPI:1114929312
Name:COWDERY, SUSAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:COWDERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 BRENTWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1871
Mailing Address - Country:US
Mailing Address - Phone:607-273-6757
Mailing Address - Fax:607-273-2854
Practice Address - Street 1:8 BRENTWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1871
Practice Address - Country:US
Practice Address - Phone:607-273-6757
Practice Address - Fax:607-273-2854
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2151422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02068793Medicaid
NYCC0585Medicare ID - Type Unspecified
NYH15988Medicare UPIN