Healthcare Provider Details

I. General information

NPI: 1760690416
Provider Name (Legal Business Name): DANIEL JONATHAN KOWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICE RD
TEMPLETON MA
01468-1332
US

IV. Provider business mailing address

PO BOX 1045
WORCESTER MA
01613-1045
US

V. Phone/Fax

Practice location:
  • Phone: 978-939-2035
  • Fax: 978-939-2039
Mailing address:
  • Phone: 978-939-2035
  • Fax: 978-939-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number231689
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: