Provider Demographics
NPI:1922443324
Name:COHEN DERMATOPATHOLOGY, PC
Entity Type:Organization
Organization Name:COHEN DERMATOPATHOLOGY, PC
Other - Org Name:INFORM DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP, COMPLIANCE, ETHICS & QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:SIMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-277-8700
Mailing Address - Street 1:6655 NORTH MACARTHUR BOULEVARD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2443
Mailing Address - Country:US
Mailing Address - Phone:214-596-7031
Mailing Address - Fax:
Practice Address - Street 1:5850 WATERLOO RD STE 140
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-766-4175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD160379Medicare PIN