Provider Demographics
NPI:1104844489
Name:COHEN, RICHARD CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
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 1:1702 SE 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3405
Mailing Address - Country:US
Mailing Address - Phone:503-234-3101
Mailing Address - Fax:
Practice Address - Street 1:501 N GRAHAM ST STE 375
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2001
Practice Address - Country:US
Practice Address - Phone:503-413-1600
Practice Address - Fax:503-413-1915
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09136208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240504Medicaid
OR240504Medicaid