Provider Demographics
NPI:1558304014
Name:COHEN, MATTHEW S (MD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1107
Mailing Address - Country:US
Mailing Address - Phone:610-664-9700
Mailing Address - Fax:610-664-6391
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1445
Practice Address - Country:US
Practice Address - Phone:215-632-3500
Practice Address - Fax:215-632-5008
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426274174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101554525Medicaid
PA101554525Medicaid