Provider Demographics
NPI:1528398450
Name:COHEN FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:COHEN FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-909-8802
Mailing Address - Street 1:5391 N CAMINO SUMO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5133
Mailing Address - Country:US
Mailing Address - Phone:520-909-8802
Mailing Address - Fax:
Practice Address - Street 1:2830 N SWAN RD
Practice Address - Street 2:SUITE 180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6306
Practice Address - Country:US
Practice Address - Phone:520-881-1805
Practice Address - Fax:520-881-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-25
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ136116Medicare PIN