Provider Demographics
NPI:1235291782
Name:COHEN, HAROLD MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:MARVIN
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HAROLD
Other - Middle Name:MARVIN
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11709 E DREYFUS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2761
Mailing Address - Country:US
Mailing Address - Phone:480-993-3545
Mailing Address - Fax:480-656-9329
Practice Address - Street 1:11709 E DREYFUS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2761
Practice Address - Country:US
Practice Address - Phone:480-993-3545
Practice Address - Fax:480-656-9329
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA58680Medicare UPIN