Provider Demographics
NPI:1548374739
Name:COWAN, DALE H (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:H
Last Name:COWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9257 PROVINCE LN
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1780
Mailing Address - Country:US
Mailing Address - Phone:216-798-2722
Mailing Address - Fax:
Practice Address - Street 1:9257 PROVINCE LN
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1780
Practice Address - Country:US
Practice Address - Phone:216-798-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35027305C207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0206039Medicaid
OHCO7347661Medicare PIN
OHA73403Medicare UPIN
OH0206039Medicaid