Provider Demographics
NPI:1619091931
Name:COWEN, STANLEY Z (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:Z
Last Name:COWEN
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:PO BOX 4478
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91313-4478
Mailing Address - Country:US
Mailing Address - Phone:818-882-7730
Mailing Address - Fax:
Practice Address - Street 1:43845 10TH ST W
Practice Address - Street 2:SUITE 2A
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4800
Practice Address - Country:US
Practice Address - Phone:818-709-8161
Practice Address - Fax:818-709-8160
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17178208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G171780OtherBLUE SHIELD
CAZZZ51689ZOtherBLUE SHIELD
CA00G171780Medicaid
CAG17178OtherLICENSE
CAWG17178CMedicare PIN
CAG17178OtherLICENSE
CAZZZ51689ZOtherBLUE SHIELD