MEDICARE: LISA RENEE COWAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	2010-01286	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093919896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RENEE COWAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 843298
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02284-3298
Country	:	US
Telephone Number	:	910-878-5100
Fax Number	:	910-878-5100

Provider Business Practice Location Address
First Line	:	4565 FAYETTEVILLE ROAD
Second Line	:	SUITE A
City	:	RAEFORD
State	:	NC
Zip	:	28376-0000
Country	:	US
Telephone Number	:	910-878-5100
Fax Number	:	910-878-5140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	03/11/2013

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