Healthcare Provider Details

I. General information

NPI: 1215597687
Provider Name (Legal Business Name): BENJAMIN COWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E 5TH ST APT 1
BOSTON MA
02127-8837
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 413-537-2754
  • Fax:
Mailing address:
  • Phone: 610-477-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1013950
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: