Provider Demographics
NPI:1639258023
Name:COHEN, GREGORY S (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-536-3520
Practice Address - Fax:916-536-3527
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1243326OtherGREAT WEST
CA6349614OtherCIGNA
CA90065857OtherPACIFICARE
CA00G637800OtherBLUE SHIELD
CA30359OtherINTERPLAN
CA503052OtherHEALTH NET
CA1122853OtherUNITED HEALTHCARE
CA5832149OtherAETNA
CAG63780OtherBLUE CROSS
CAMCMG124200OtherWESTERN HEALTH ADVANTAGE
CA000810342987OtherPHCS
CA00G637800Medicaid
CA507858OtherFIRST HEALTH
CA1243326OtherGREAT WEST
CA30359OtherINTERPLAN