Provider Demographics
NPI:1184676462
Name:COHEN, GARY I (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:I
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:PO BOX 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6831
Practice Address - Country:US
Practice Address - Phone:443-849-3051
Practice Address - Fax:443-849-3057
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27730207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259581800Medicaid
MDKJ44GB/39930502OtherCAREFIRST MARYLAND GBMC
MDS1240003OtherCAREFIRST REGIONAL GBMC
MDKJ44GB/39930502OtherCAREFIRST MARYLAND GBMC
D74577Medicare UPIN
MD259581800Medicaid
MD705L423DMedicare PIN