Provider Demographics
NPI:1326142738
Name:COHEN, ELLIOT SANFORD (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:SANFORD
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 1:4465 NORTHPARK DRIVE
Mailing Address - Street 2:#208
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-531-5700
Mailing Address - Fax:719-531-5712
Practice Address - Street 1:4465 NORTHPARK DRIVE
Practice Address - Street 2:#208
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-531-5700
Practice Address - Fax:719-531-5712
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO226172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01226174Medicaid
1918-1Medicare ID - Type Unspecified
CO01226174Medicaid