Provider Demographics
NPI:1508829151
Name:COHEN, STANLEY G (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:G
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 1:12582 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1907
Mailing Address - Country:US
Mailing Address - Phone:714-534-0744
Mailing Address - Fax:714-534-0785
Practice Address - Street 1:12582 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1907
Practice Address - Country:US
Practice Address - Phone:714-534-0744
Practice Address - Fax:714-534-0785
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8949208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00708070OtherMEDICARE RAILROAD
BC012Medicare PIN