Provider Demographics
NPI:1851405179
Name:COHEN, HARRY G (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:G
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 1:3929 VILLA COSTERA
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5151
Mailing Address - Country:US
Mailing Address - Phone:818-414-6000
Mailing Address - Fax:310-456-2895
Practice Address - Street 1:3929 VILLA COSTERA
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5151
Practice Address - Country:US
Practice Address - Phone:818-414-6000
Practice Address - Fax:310-456-2895
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20648207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG20648OtherLICENSE
CAA90661Medicare UPIN
CAWG20648AMedicare PIN