Individual
CHARLES RICHARDSON COWAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14519 DETROIT AVE, LAKEWOOD, OH 44107-4316
(216) 521-4200
Mailing address
16616 ALDERSYDE DR, SHAKER HTS, OH 44120-2514
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35081096C
OH
207Q00000X
Family Medicine Physician
35081096
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000380937
ANTHEM BC/BS
OH
05
—
2373239
—
OH
01
—
341542312098
CARESOURCE
OH
01
—
378646
WELLCARE
OH
Enumeration date
05/28/2006
Last updated
05/07/2008
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