Provider Demographics
NPI:1235879446
Name:COHEN, OLIVIA GRACE (MSPH, MD)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:GRACE
Last Name:COHEN
Suffix:
Gender:F
Credentials:MSPH, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LEE STREET BOX 800718
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-924-5115
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-2696
Practice Address - Country:US
Practice Address - Phone:434-924-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
VA0116037510390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program