Healthcare Provider Details

I. General information

NPI: 1922087204
Provider Name (Legal Business Name): JANET MARY COWAN PH.D., FACMG
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST T-NEMC 188
BOSTON MA
02111-1526
US

IV. Provider business mailing address

750 WASHINGTON ST T-NEMC 188
BOSTON MA
02111-1526
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5841
  • Fax: 617-636-1256
Mailing address:
  • Phone: 617-636-5841
  • Fax: 617-636-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number870077
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: