Provider Demographics
NPI:1689614885
Name:COHEN, ROBERT MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
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 1:2390 WALL ST SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2186
Mailing Address - Country:US
Mailing Address - Phone:770-922-5696
Mailing Address - Fax:770-922-4353
Practice Address - Street 1:2390 WALL ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2186
Practice Address - Country:US
Practice Address - Phone:770-922-5696
Practice Address - Fax:770-922-4353
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027520207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03BDBGSMedicare ID - Type Unspecified
GAD87765Medicare UPIN