Provider Demographics
NPI:1710909650
Name:STANLEY L. COHAN, MD, CHARTERED
Entity Type:Organization
Organization Name:STANLEY L. COHAN, MD, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:503-296-9242
Mailing Address - Street 1:9427 SW BARNES RD
Mailing Address - Street 2:SUITE 595
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6652
Mailing Address - Country:US
Mailing Address - Phone:503-296-9242
Mailing Address - Fax:503-296-9856
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:SUITE 595
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-296-9242
Practice Address - Fax:503-296-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC61881Medicare UPIN