Provider Demographics
NPI:1497971642
Name:HAROLD L. COHEN, M.D., LLC
Entity Type:Organization
Organization Name:HAROLD L. COHEN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-847-8615
Mailing Address - Street 1:811 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2212
Mailing Address - Country:US
Mailing Address - Phone:812-332-1401
Mailing Address - Fax:812-332-3062
Practice Address - Street 1:2160 E STATE HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9407
Practice Address - Country:US
Practice Address - Phone:812-847-8615
Practice Address - Fax:812-847-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060284A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200519570Medicaid
IN227050Medicare ID - Type Unspecified
IN200519570Medicaid