Provider Demographics
NPI:1275569055
Name:COHEN, SANDRA W (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:W
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT # 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-7888
Mailing Address - Fax:901-266-6445
Practice Address - Street 1:57 GERMANTOWN CT
Practice Address - Street 2:SUITE 100
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7273
Practice Address - Country:US
Practice Address - Phone:901-758-7888
Practice Address - Fax:901-266-6445
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY147466207RG0300X
TN44372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513556Medicaid
TNP01246356OtherRAILROAD MEDICARE
TN4355484OtherBCBS
AR177839001Medicaid
MS00728228Medicaid
TN1513556Medicaid
C11525Medicare UPIN