Healthcare Provider Details

I. General information

NPI: 1669737045
Provider Name (Legal Business Name): JARED R COWAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EXCELA HEALTH DR STE 203B
LATROBE PA
15650-9001
US

IV. Provider business mailing address

100 EXCELA HEALTH DR STE 203B
LATROBE PA
15650-9001
US

V. Phone/Fax

Practice location:
  • Phone: 724-532-0866
  • Fax: 724-532-0869
Mailing address:
  • Phone: 724-532-0866
  • Fax: 724-532-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055614
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: