Provider Demographics
NPI:1447234356
Name:COHEN, LAWRENCE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MICHAEL
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 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1100
Mailing Address - Fax:952-942-3361
Practice Address - Street 1:5104 BRADLEY BLVD
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6526
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:952-942-3361
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD142952085R0202X
MDD00345402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
470001526OtherRR MEDICARE
300135370OtherRR MEDICARE
MD330581301Medicaid
DC007445W30Medicare PIN
MD784M358FMedicare PIN
MDFMX003Medicare PIN
470001526OtherRR MEDICARE
DC00B422O31Medicare PIN
MD330581301Medicaid