Provider Demographics
NPI:1801867361
Name:COWAN, JENNIFER T (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:T
Last Name:COWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:TURSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2301 S. BROAD STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3542
Mailing Address - Country:US
Mailing Address - Phone:215-551-8660
Mailing Address - Fax:215-551-9247
Practice Address - Street 1:2301 S. BROAD STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3542
Practice Address - Country:US
Practice Address - Phone:215-551-8660
Practice Address - Fax:215-551-9247
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069214L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001797674Medicaid
MAAA12578OtherHARVARD PILGRIM
MA2068460Medicaid
MA469194OtherTUFTS
NJ8195404Medicaid
MAJ27491OtherBLUE CROSS
MA2068460Medicaid
MAAA12578OtherHARVARD PILGRIM
PA039063Medicare PIN