Provider Demographics
NPI:1548392350
Name:MONUMENT UROLOGY, PC
Entity Type:Organization
Organization Name:MONUMENT UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:COWDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-447-6253
Mailing Address - Street 1:140 HOSPITAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5009
Mailing Address - Country:US
Mailing Address - Phone:802-447-6253
Mailing Address - Fax:802-442-3017
Practice Address - Street 1:140 HOSPITAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5009
Practice Address - Country:US
Practice Address - Phone:802-447-6253
Practice Address - Fax:802-442-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010380174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010583Medicaid
VT1010583Medicaid
VTH63834Medicare UPIN