Provider Demographics
NPI:1376576215
Name:COHEN, JAMIE (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
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 1:7255 OLD OAK BLVD STE C208
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3300
Mailing Address - Country:US
Mailing Address - Phone:440-816-2708
Mailing Address - Fax:440-243-8480
Practice Address - Street 1:7255 OLD OAK BLVD STE C208
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3300
Practice Address - Country:US
Practice Address - Phone:440-816-2708
Practice Address - Fax:440-243-8480
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086812207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7132734OtherAETNA
OH2607674Medicaid
OHP86812OtherSUMMACARE
OH000000376998OtherANTHEM BLUE CROSS/BLUE SH
OH4169371OtherRAILROAD MEDICARE
OH1007514OtherQUALCHOICE
OH341487428OtherTAX ID
OH4169371OtherRAILROAD MEDICARE
OH4169371Medicare ID - Type Unspecified