Provider Demographics
NPI:1184667420
Name:COWPATH PEDIATRICS, LLC
Entity Type:Organization
Organization Name:COWPATH PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIBONO
Authorized Official - Last Name:ETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-855-1599
Mailing Address - Street 1:108 COWPATH RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1152
Mailing Address - Country:US
Mailing Address - Phone:215-855-1599
Mailing Address - Fax:
Practice Address - Street 1:108 COWPATH RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1152
Practice Address - Country:US
Practice Address - Phone:215-855-1599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004397L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty