Provider Demographics
NPI:1649227620
Name:COWEN, JILL M (PAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:COWEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3685
Mailing Address - Country:US
Mailing Address - Phone:717-920-4400
Mailing Address - Fax:
Practice Address - Street 1:2808 OLD POST RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3685
Practice Address - Country:US
Practice Address - Phone:717-920-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA74956Medicare ID - Type Unspecified
Q01898Medicare UPIN