Provider Demographics
NPI:1891714358
Name:COWAN, MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:COWAN
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 1:23 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1331
Mailing Address - Country:US
Mailing Address - Phone:845-794-5558
Mailing Address - Fax:845-794-0135
Practice Address - Street 1:23 HIGH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1331
Practice Address - Country:US
Practice Address - Phone:845-794-5558
Practice Address - Fax:845-794-0135
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090532207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00528010Medicaid
NY3878OtherGHIHMO
NY27334OtherBLUE CROSS
NY27436OtherAETNA
NY0041203OtherGHI
NY167101OtherMVP
NYP423820OtherOXFORD HEALTH PLANS
NY0041203OtherGHI
NY273342Medicare ID - Type Unspecified