Provider Demographics
NPI:1083896096
Name:GLENN D. COHEN, MD INC.
Entity Type:Organization
Organization Name:GLENN D. COHEN, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-370-6877
Mailing Address - Street 1:1014 S WESTLAKE BLVD
Mailing Address - Street 2:SUITE 14 PMB 228
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3108
Mailing Address - Country:US
Mailing Address - Phone:805-370-6877
Mailing Address - Fax:805-777-7411
Practice Address - Street 1:696 HAMPSHIRE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2635
Practice Address - Country:US
Practice Address - Phone:805-370-6877
Practice Address - Fax:805-777-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55543174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29787Medicare UPIN
CA4615840001Medicare NSC
CAW21719Medicare PIN