Provider Demographics
NPI:1194002907
Name:COHEN, BAMBI ELAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:BAMBI
Middle Name:ELAYNE
Last Name:COHEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:B.
Other - Middle Name:ELAYNE
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 45962
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5962
Mailing Address - Country:US
Mailing Address - Phone:410-469-4178
Mailing Address - Fax:410-469-4160
Practice Address - Street 1:295 STONER AVE STE 102
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5662
Practice Address - Country:US
Practice Address - Phone:410-848-1818
Practice Address - Fax:410-848-1256
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03207363AS0400X
MDC05397363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical