Provider Demographics
NPI:1013948298
Name:COHEN, SHOSHANA (OD)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3416
Mailing Address - Country:US
Mailing Address - Phone:410-752-1677
Mailing Address - Fax:410-752-4435
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 225
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-653-0200
Practice Address - Fax:410-653-3667
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD613137OtherBCBS
MD693L387DMedicare PIN
MD613137OtherBCBS
MDU73628Medicare UPIN