Provider Demographics
NPI:1306833199
Name:COHEN, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-733-8821
Mailing Address - Fax:804-861-4365
Practice Address - Street 1:50 MEDICAL PARK BOULEVARD
Practice Address - Street 2:SUITE C & D
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9289
Practice Address - Country:US
Practice Address - Phone:804-733-8821
Practice Address - Fax:804-861-4365
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006097871Medicaid
VA110001686Medicare PIN
VAB05399Medicare UPIN