Provider Demographics
NPI:1336230317
Name:KOWALSKI, JAMES VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VINCENT
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3424
Mailing Address - Country:US
Mailing Address - Phone:508-778-1772
Mailing Address - Fax:508-778-4062
Practice Address - Street 1:795 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3424
Practice Address - Country:US
Practice Address - Phone:508-778-1772
Practice Address - Fax:508-778-4062
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56263207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E03305Medicare UPIN
Y02464Medicare ID - Type Unspecified