Provider Demographics
NPI:1346249661
Name:COHEN, AVRAHM (MD)
Entity Type:Individual
Prefix:
First Name:AVRAHM
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 1329
Mailing Address - Street 2:SUITE 906
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-1329
Mailing Address - Country:US
Mailing Address - Phone:901-751-5404
Mailing Address - Fax:901-757-9065
Practice Address - Street 1:6296 MAISON PRIVEE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4221
Practice Address - Country:US
Practice Address - Phone:901-751-5404
Practice Address - Fax:901-757-9065
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0238-C207RC0000X
TNMD41457207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000128625OtherANTHEM
OH110023951OtherMEDICARE RAILROADERS
OH0601398Medicaid
OH110023951OtherMEDICARE RAILROADERS
TN38285311Medicare PIN
OH0601398Medicaid
OHA15890Medicare UPIN
TN3828531Medicare ID - Type Unspecified