Provider Demographics
NPI:1487795993
Name:COWAN, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:COWAN
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 1:102 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 230 BENBROOK MEDICAL CENTER 1
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1784
Mailing Address - Country:US
Mailing Address - Phone:877-661-3376
Mailing Address - Fax:
Practice Address - Street 1:102 TECHNOLOGY DR
Practice Address - Street 2:SUITE 230 BENBROOK MEDICAL CENTER 1
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1784
Practice Address - Country:US
Practice Address - Phone:877-661-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037215207N00000X, 207ND0101X
MDD67402207N00000X
MDD0067402207ND0101X
PAMD439184207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102448590Medicaid
PA181687Medicare PIN