MEDICARE: DR. DONALD WALTER KOWALSKI MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	156437-1	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00473247	OTHER		MEDICARE RAILROAD PART B

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000406632004	OTHER	BLUESHIELD OF NORTHEASTERN NY
3	11056587	OTHER	CAQH
4	53088A	OTHER	MVP
5	080305000106	OTHER	FIDELIS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1134199078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD WALTER KOWALSKI MD

Provider Business Mailing Address
First Line	:	3043 STATE ROUTE 4
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-9632
Country	:	US
Telephone Number	:	518-747-2284
Fax Number	:	518-747-2253

Provider Business Practice Location Address
First Line	:	3043 STATE ROUTE 4
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-9632
Country	:	US
Telephone Number	:	518-747-2284
Fax Number	:	518-747-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	02/26/2010

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

3043 STATE ROUTE 4
HUDSON FALLS, NY
12839-9632