1366402588 NPI number — MARK A KOWALSKI M.D.

Table of content: MARK A KOWALSKI M.D. (NPI 1366402588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366402588 NPI number — MARK A KOWALSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOWALSKI
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366402588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 POPLAR ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
MILLINOCKET
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04462-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-723-3003
Provider Business Mailing Address Fax Number:
207-723-3006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 POPLAR ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MILLINOCKET
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04462-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-723-3003
Provider Business Practice Location Address Fax Number:
207-723-3006
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  016015 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022326 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 4203395 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: F10120 . This is a "HARVARD PILGRAM HEALTHCAR" identifier . This identifiers is of the category "OTHER".




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