Provider Demographics
NPI:1659332211
Name:COWART, ELLIOTT F III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:F
Last Name:COWART
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:3998 FAIR RIDGE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-4305
Practice Address - Fax:518-262-4736
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166726367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00730615OtherRAILROAD MEDICARE
NYA400104489Medicare PIN
NYG400147861Medicare PIN