Provider Demographics
NPI:1649234188
Name:COHAN, MATTHEW TODD (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TODD
Last Name:COHAN
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 1:6633 COYLE AVE
Mailing Address - Street 2:2
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6346
Mailing Address - Country:US
Mailing Address - Phone:916-965-6560
Mailing Address - Fax:916-965-5672
Practice Address - Street 1:6633 COYLE AVE
Practice Address - Street 2:2
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6346
Practice Address - Country:US
Practice Address - Phone:916-965-6560
Practice Address - Fax:916-965-5672
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A41166Medicaid
CA00A41166Medicaid