1467085712 NPI number — MR. AIDAN C. MCCOWN OTR/L

Table of content: NATASHA DAWN GARVER FNP (NPI 1518905298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467085712 NPI number — MR. AIDAN C. MCCOWN OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCOWN
Provider First Name:
AIDAN
Provider Middle Name:
C.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
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:
1467085712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8344 WHEATON HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14572-9314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-490-0835
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14437-9798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-335-6770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2020

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: 225X00000X , with the licence number:  020849-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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