Provider Demographics
NPI:1033118617
Name:COHEN, PETER RONALD (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:RONALD
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 1:5450 KNOLL NORTH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2373
Mailing Address - Country:US
Mailing Address - Phone:410-715-1180
Mailing Address - Fax:410-715-1182
Practice Address - Street 1:5450 KNOLL NORTH DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2373
Practice Address - Country:US
Practice Address - Phone:410-715-1180
Practice Address - Fax:410-715-1182
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00271222084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE01302Medicare UPIN