Provider Demographics
NPI:1023071065
Name:COHN, JOSEPH DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:COHN
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 1:6552 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5886
Mailing Address - Country:US
Mailing Address - Phone:707-480-8702
Mailing Address - Fax:707-578-6701
Practice Address - Street 1:6552 PINE VALLEY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5886
Practice Address - Country:US
Practice Address - Phone:707-480-8702
Practice Address - Fax:707-578-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8016208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020048889OtherRR MEDICARE
CA000G80160Medicaid
CA000G80160Medicare ID - Type Unspecified