Provider Demographics
NPI:1275506370
Name:COHEN, ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
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 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5168
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:22 N MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2344
Practice Address - Country:US
Practice Address - Phone:540-213-2630
Practice Address - Fax:540-213-2631
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherCIGNA
VA010162505Medicaid
VA12586OtherSENTARA/OPTIMA
VA541595397OtherTRICARE
VA136968OtherANTHEM
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA4000196OtherAETNA
VA541595397OtherMID ATLANTIC SOLUTIONS
VA541595397OtherVIRGINIA HEALTH NETWORK
VAGC1100Medicare PIN
VA541595397OtherVIRGINIA HEALTH NETWORK
004612B28Medicare PIN