Healthcare Provider Details

I. General information

NPI: 1649246802
Provider Name (Legal Business Name): TODD D. COWEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 NORTH ACADIA ROAD, SUITE 100
THIBODAUX LA
70301-6712
US

IV. Provider business mailing address

726 N ACADIA RD SUITE 2600
THIBODAUX LA
70301-5009
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-9922
  • Fax: 985-447-9006
Mailing address:
  • Phone: 985-447-9922
  • Fax: 985-447-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number021323
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: