Provider Demographics
NPI:1003241878
Name:COHEN, STEPHEN NORRIS (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NORRIS
Last Name:COHEN
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 1:40 VENTURA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1443
Mailing Address - Country:US
Mailing Address - Phone:415-681-2171
Mailing Address - Fax:415-681-2171
Practice Address - Street 1:40 VENTURA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1443
Practice Address - Country:US
Practice Address - Phone:415-681-2171
Practice Address - Fax:415-681-2171
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE13992207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G139920Medicare PIN
CAA39142Medicare UPIN