Provider Demographics
NPI:1932216538
Name:COWEN, LEE ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANDREW
Last Name:COWEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5285 NW 21ST DIAGONAL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3461
Mailing Address - Country:US
Mailing Address - Phone:215-370-5559
Mailing Address - Fax:
Practice Address - Street 1:5285 NW 21ST DIAGONAL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3461
Practice Address - Country:US
Practice Address - Phone:215-370-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8032207RG0300X, 207RH0002X, 207RH0002X
PAOS004834L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014438820001Medicaid
PA561186Medicare PIN
PA0014438820001Medicaid