Provider Demographics
NPI:1336177666
Name:COWDERY, SUSAN L (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:COWDERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA
Mailing Address - Street 2:SUITE 2502
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 LANCASTER PIKE
Practice Address - Street 2:SUITE 9
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-0000
Practice Address - Country:US
Practice Address - Phone:302-830-5297
Practice Address - Fax:302-656-5270
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031638E207R00000X, 207RR0500X
DEC1-0009265207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1538151OtherGATEWAY-WMG
PA0092050000OtherAMERIHEALTH 65 PA
PA199708OtherHIGHMARK BLUE SHIELD
MD640457OtherCAREFIRST MD BCBS
PA001136649Medicaid
PA50065256OtherCAPITAL BLUE CROSS-WMG
PA107048OtherJOHNS HOPKINS
PA20033517OtherAMERIHEALTH MERCY-WMG
PA5833490OtherAETNA
PA100440OtherGEISINGER
PA153402OtherUNISON-WMG
PA2127067OtherMAMSI-WMG
PA199708OtherHIGHMARK BLUE SHIELD
PA199708FLTMedicare PIN
PA1538151OtherGATEWAY-WMG
PAP00194323Medicare PIN