Provider Demographics
NPI:1225094709
Name:COWEN, GREG L (PA-C)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:L
Last Name:COWEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 FOUNTAIN CT
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1895
Mailing Address - Country:US
Mailing Address - Phone:859-276-5008
Mailing Address - Fax:859-278-6401
Practice Address - Street 1:230 FOUNTAIN CT
Practice Address - Street 2:SUITE 180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1895
Practice Address - Country:US
Practice Address - Phone:859-276-5008
Practice Address - Fax:859-278-6401
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN863363A00000X, 207P00000X
KYPA293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000831284OtherANTHEM
KYP01229485OtherRAILROAD MEDICARE
TN3668052Medicaid
TN103I197206Medicare PIN
KY000000831284OtherANTHEM
KYK099060Medicare PIN
KYP01229485OtherRAILROAD MEDICARE
TN3668052Medicare PIN
IL206813012Medicare PIN