MEDICARE: DR. MARIA D KOWAL 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	208000000X	Pediatrics Physician	35076188K	OH

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	:	1871593632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA D KOWAL M.D.

Provider Business Mailing Address
First Line	:	2642 ELM RD NE
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9393
Country	:	US
Telephone Number	:	330-841-5500
Fax Number	:	330-841-5510

Provider Business Practice Location Address
First Line	:	2642 ELM RD NE
Second Line	:
City	:	CORTLAND
State	:	OH
Zip	:	44410-9393
Country	:	US
Telephone Number	:	330-841-5500
Fax Number	:	330-841-5510

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/27/2013

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