Provider Demographics
NPI:1780975706
Name:COWAN, MATTHEW WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:COWAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3332 ROCHAMBEAU AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2836
Mailing Address - Country:US
Mailing Address - Phone:718-920-6311
Mailing Address - Fax:718-920-6313
Practice Address - Street 1:3332 ROCHAMBEAU AVE STE C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2836
Practice Address - Country:US
Practice Address - Phone:718-920-6311
Practice Address - Fax:718-920-6313
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310909207VX0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400227467OtherMEDICARE PTAN