Provider Demographics
NPI:1952450769
Name:COHAN, GARY ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ROSS
Last Name:COHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:150 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2142
Mailing Address - Country:US
Mailing Address - Phone:310-657-6900
Mailing Address - Fax:310-657-6901
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2142
Practice Address - Country:US
Practice Address - Phone:310-657-6900
Practice Address - Fax:310-657-6901
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG74832OtherCA MEDICAL LICENSE
CABC1598525OtherDEA LICENSE NUMBER
CABC1598525OtherDEA LICENSE NUMBER
CAWG74832CMedicare ID - Type Unspecified