Provider Demographics
NPI:1518903095
Name:KOWALEWSKY, ANDREW JR (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KOWALEWSKY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:KOWALEWSKY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-906-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2013887Medicaid
G50590Medicare UPIN
OHKO0822723Medicare ID - Type Unspecified
OH080194981Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH1062950013Medicare NSC