Provider Demographics
NPI:1205024585
Name:MARIANNE COWLEY, M.D.,PLC
Entity Type:Organization
Organization Name:MARIANNE COWLEY, M.D.,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-499-8980
Mailing Address - Street 1:3103 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2798
Mailing Address - Country:US
Mailing Address - Phone:502-499-8980
Mailing Address - Fax:502-499-8294
Practice Address - Street 1:3103 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2798
Practice Address - Country:US
Practice Address - Phone:502-499-8980
Practice Address - Fax:502-499-8294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24468207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100394270AMedicaid
KY64244684Medicaid
KY7491OtherMEDICARE GROUP
KY64244684Medicaid