Provider Demographics
NPI:1891852125
Name:COHEN, THOMAS L (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
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:PO BOX 1427
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-1427
Mailing Address - Country:US
Mailing Address - Phone:423-566-8283
Mailing Address - Fax:423-566-5896
Practice Address - Street 1:923 E CENTRAL AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2768
Practice Address - Country:US
Practice Address - Phone:423-566-8283
Practice Address - Fax:423-566-5896
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3386057Medicaid
TNA99915Medicare UPIN
TN3386057Medicaid