Provider Demographics
NPI:1437167210
Name:COHEN, IAN M (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:M
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 1:140 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2505
Mailing Address - Country:US
Mailing Address - Phone:203-755-2344
Mailing Address - Fax:203-573-8166
Practice Address - Street 1:140 GRANDVIEW AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2505
Practice Address - Country:US
Practice Address - Phone:203-755-2344
Practice Address - Fax:203-573-8166
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018170207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0228487OtherCIGNA PROVIDER NUMBER
CT128561OtherWELLCARE PROVIDER #
CT0740436OtherUNITED HEALTHCARE
CTORO791OtherHEALTHNET PROVIDER #
CT01008170CT01OtherANTHEM FAMILY PLAN NUMBER
CT752412OtherCONNECTICARE PROVIDER #
CT010018170CT01OtherANTHEM PROVIDER NUMBER
CTNHP011OtherOXFORD PROVIDER NUMBER
CT83722OtherUS HEALTHCARE PROVIDER #
CTORO791OtherHEALTHNET PROVIDER #