Individual
DR. LARRY A COWLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
106 WADSWORTH ST, RADFORD, VA 24141-1439
(540) 639-9023
(540) 639-5463
Mailing address
106 WADSWORTH ST, RADFORD, VA 24141-1439
(540) 639-9023
(540) 381-1462
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0101038901
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006580271
—
VA
01
—
01201038901
STATE LICENSE
VA
01
—
075730
ANTHEM PROVIDER NUMBER
VA
01
—
5757016
AETNA PROVIDER NUMBER
—
Enumeration date
08/15/2006
Last updated
01/05/2015
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