Healthcare Provider Details

I. General information

NPI: 1871593632
Provider Name (Legal Business Name): MARIA D KOWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 ELM RD NE
CORTLAND OH
44410-9393
US

IV. Provider business mailing address

2642 ELM RD NE
CORTLAND OH
44410-9393
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-5500
  • Fax: 330-841-5510
Mailing address:
  • Phone: 330-841-5500
  • Fax: 330-841-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35076188K
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: