Provider Demographics
NPI:1710979224
Name:COHEN, GARY MEIR (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MEIR
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 1:7131 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3251
Mailing Address - Country:US
Mailing Address - Phone:215-483-2113
Mailing Address - Fax:215-483-8012
Practice Address - Street 1:7131 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3251
Practice Address - Country:US
Practice Address - Phone:215-483-2113
Practice Address - Fax:215-483-8012
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070235L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018125740001Medicaid
PA040463EURMedicare ID - Type Unspecified
PA0018125740001Medicaid