Provider Demographics
NPI:1376545053
Name:COHEN, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 W 3RD AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1941
Mailing Address - Country:US
Mailing Address - Phone:229-431-1022
Mailing Address - Fax:229-431-2068
Practice Address - Street 1:425 W 3RD AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1941
Practice Address - Country:US
Practice Address - Phone:229-431-1022
Practice Address - Fax:229-431-2068
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01029427A207RC0000X, 207RI0011X
GA62107207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA879450752AMedicaid
GAD80406Medicare UPIN