Provider Demographics
NPI:1326046186
Name:COWAN, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
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 1:3907 POMFRET LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3729
Mailing Address - Country:US
Mailing Address - Phone:704-534-2826
Mailing Address - Fax:
Practice Address - Street 1:223 HERLONG AVE S OFC
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1670
Practice Address - Country:US
Practice Address - Phone:704-534-2826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900805207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00806Medicaid
NC891233TMedicaid
140006319OtherRAILROAD MEDICARE
SCH018106191Medicare PIN
140006319OtherRAILROAD MEDICARE
NC2279677Medicare PIN