Provider Demographics
NPI:1003929779
Name:MICHAEL D. COHEN, M.D., P.A.
Entity type:Organization
Organization Name:MICHAEL D. COHEN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-296-0414
Mailing Address - Street 1:8322 BELLONA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2012
Mailing Address - Country:US
Mailing Address - Phone:410-296-0414
Mailing Address - Fax:410-296-0412
Practice Address - Street 1:8322 BELLONA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-296-0414
Practice Address - Fax:410-296-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF00626Medicare UPIN
MDH20834Medicare UPIN
MD735MN825Medicare ID - Type UnspecifiedLARRY H. LICKSTEIN, M.D.
MD735M282FMedicare ID - Type UnspecifiedMICHAEL D. COHEN, M.D.