Provider Demographics
NPI:1356469258
Name:COWALL, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:COWALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 OLD OCEAN CITY RD
Mailing Address - Street 2:COASTAL HOSPICE, INC.
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-4629
Mailing Address - Country:US
Mailing Address - Phone:410-742-8732
Mailing Address - Fax:
Practice Address - Street 1:2604 OLD OCEAN CITY RD
Practice Address - Street 2:COASTAL HOSPICE, INC.
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4629
Practice Address - Country:US
Practice Address - Phone:410-742-8732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26278174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD26278OtherLICENSE
205PMedicare ID - Type Unspecified
MD26278OtherLICENSE