Provider Demographics
NPI:1013054865
Name:COHEN-GADOL, SHARIAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARIAR
Middle Name:
Last Name:COHEN-GADOL
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 1:566 SAINT CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3953
Mailing Address - Country:US
Mailing Address - Phone:805-449-8781
Mailing Address - Fax:805-449-4224
Practice Address - Street 1:566 SAINT CHARLES DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3953
Practice Address - Country:US
Practice Address - Phone:805-449-8781
Practice Address - Fax:805-449-4224
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1200X
CAA88619207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88619OtherMEDICAL LICENSE
CACF628ZMedicare PIN