Healthcare Provider Details

I. General information

NPI: 1215991773
Provider Name (Legal Business Name): PHILIP KOWASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 INDUSTRIAL PARK RD
SACO ME
04072-1804
US

IV. Provider business mailing address

9 HEALTHCARE DRIVE SUITE 201
BIDDEFORD ME
04005-3747
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-8800
  • Fax: 207-286-9853
Mailing address:
  • Phone: 207-282-9080
  • Fax: 207-282-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014701
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: