Provider Demographics
NPI:1346424462
Name:COHEN, GARY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
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 1:9833 PACIFIC HEIGHTS BLVD
Mailing Address - Street 2:STE J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4074
Mailing Address - Country:US
Mailing Address - Phone:858-458-0940
Mailing Address - Fax:858-458-3688
Practice Address - Street 1:9833 PACIFIC HEIGHTS BLVD
Practice Address - Street 2:STE J
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4074
Practice Address - Country:US
Practice Address - Phone:858-458-0940
Practice Address - Fax:858-458-3688
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43070207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG43070AMedicare PIN
CAW8746Medicare UPIN