Provider Demographics
NPI:1851488191
Name:COHEN, IVAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1305 POST ROAD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6018
Mailing Address - Country:US
Mailing Address - Phone:203-259-7709
Mailing Address - Fax:203-255-3585
Practice Address - Street 1:1305 POST ROAD
Practice Address - Street 2:SUITE 310
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6018
Practice Address - Country:US
Practice Address - Phone:203-259-7709
Practice Address - Fax:203-255-3585
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14371207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38686Medicare UPIN
070000460Medicare ID - Type Unspecified