Provider Demographics
NPI:1710909221
Name:COHEN, EVE K (MD)
Entity Type:Individual
Prefix:DR
First Name:EVE
Middle Name:K
Last Name:COHEN
Suffix:
Gender:F
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:PO BOX 4130
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-4130
Mailing Address - Country:US
Mailing Address - Phone:505-470-5380
Mailing Address - Fax:
Practice Address - Street 1:5 LOS PINONEROS CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-5913
Practice Address - Country:US
Practice Address - Phone:505-470-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ5332Medicaid
NMJ5332Medicaid
SANTF011Medicare PIN
300098530Medicare PIN