MEDICARE: RONALD COWEN DO

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	207Q00000X	Family Medicine Physician	05002312L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	CD4829	OTHER	PA	RAILROAD MEDICARE TPI GROUP
12	080114274	OTHER	PA	RAILROAD MEDICARE
13	597586	OTHER	PA	MEDICARE GROUP TPI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041709	OTHER	PA	HIGHMARK BLUE SHIELD
2	1001463	OTHER	PA	KEYSTONE MERCY HEALTH
3	2Y0377	OTHER	PA	HEALTH NET
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0460696	OTHER	PA	AETNA HMO
6	544675	OTHER	PA	COVENTRY HEALTH AMERICA
7	5528438	OTHER	PA	AETNA PPO
8	698	OTHER	PA	BRAVO HEALTH
10	PHP081	OTHER	PA	OXFORD
11	0057925000	OTHER	PA	INDEPENDENCE BLUE CROSS

General Provider Information

NPI Number	:	1790769917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD COWEN DO

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-226-8800
Fax Number	:	215-226-8819

Provider Business Practice Location Address
First Line	:	1300 W LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2701
Country	:	US
Telephone Number	:	215-226-8800
Fax Number	:	215-226-8819

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	10/04/2013

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Directions to “ RONALD COWEN DO” Practice Location

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