Provider Demographics
NPI:1336117506
Name:COHEN, TERRY A (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LN
Practice Address - Street 2:SUITE 301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4707
Practice Address - Country:US
Practice Address - Phone:502-896-2500
Practice Address - Fax:502-896-2527
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY301062080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000744500OtherANTHEM- KCNS
KY64301062Medicaid
IN200096000Medicaid
KY50035394OtherPASSPORT- KCNS
KYG26698Medicare UPIN
KY50035394OtherPASSPORT- KCNS