Provider Demographics
NPI:1386671428
Name:COHEN, RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
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 1:201 W BLUE STARR DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4227
Mailing Address - Country:US
Mailing Address - Phone:918-236-7956
Mailing Address - Fax:918-708-1883
Practice Address - Street 1:201 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4227
Practice Address - Country:US
Practice Address - Phone:918-236-7956
Practice Address - Fax:918-708-1883
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106933207RC0000X
OK14107207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100105400AMedicaid
OKD38705Medicare UPIN
OK100105400AMedicaid
OKP00285032Medicare PIN