Healthcare Provider Details

I. General information

NPI: 1336230317
Provider Name (Legal Business Name): JAMES VINCENT KOWALSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WEST MAIN ST
HYANNIS MA
02601-3424
US

IV. Provider business mailing address

795 WEST MAIN ST
HYANNIS MA
02601-3424
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-1772
  • Fax: 508-778-4062
Mailing address:
  • Phone: 508-778-1772
  • Fax: 508-778-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number56263
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: