Provider Demographics
NPI:1831145127
Name:COHEN-COLSON, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:COHEN-COLSON
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 1:5750 A SOUTHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3316
Mailing Address - Country:US
Mailing Address - Phone:251-450-2211
Mailing Address - Fax:251-662-7297
Practice Address - Street 1:7280 SELLERS LN
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-4646
Practice Address - Country:US
Practice Address - Phone:251-450-2211
Practice Address - Fax:251-662-7297
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL320492084P0800X
MS19573207R00000X, 2084P0800X
AL199763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017968820009Medicaid
PA50013237OtherCAPITAL BLUE CROSS
PA422919OtherHIGHMARK BLUE SHIELD
AL102I261096Medicare UPIN
PA038277Medicare ID - Type Unspecified
PAH17147Medicare UPIN