Provider Demographics
NPI: | 1467687962 |
---|---|
Name: | COHEN, JEFFREY ERIC (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JEFFREY |
Middle Name: | ERIC |
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: | 110 IRVING ST NW STE 6D15 |
Mailing Address - Street 2: | |
Mailing Address - City: | WASHINGTON |
Mailing Address - State: | DC |
Mailing Address - Zip Code: | 20010-3017 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 202-877-7532 |
Mailing Address - Fax: | 202-877-0829 |
Practice Address - Street 1: | 110 IRVING ST NW STE 6D15 |
Practice Address - Street 2: | |
Practice Address - City: | WASHINGTON |
Practice Address - State: | DC |
Practice Address - Zip Code: | 20010-3017 |
Practice Address - Country: | US |
Practice Address - Phone: | 202-877-7532 |
Practice Address - Fax: | 202-877-0829 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-05-28 |
Last Update Date: | 2019-09-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MT195497 | 208600000X, 390200000X |
DC | MD047628 | 208G00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |