Provider Demographics
NPI:1023044096
Name:COHEN, MYLAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:MYLAN
Middle Name:C
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 1:301C US ROUTE ONE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:96 CAMPUS DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-885-9905
Practice Address - Fax:207-396-5600
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD14693207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011330Medicaid
ME207450099Medicaid
025039OtherANTHEM
MEMM7064Medicare PIN
MEMM706404Medicare PIN
NH30011330Medicaid
MEP01035658Medicare PIN
ME060048891Medicare PIN
ME207450099Medicaid