Provider Demographics
NPI:1255750600
Name:MIRAKOV COHEN, JESSICA IRIT (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:IRIT
Last Name:MIRAKOV COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 E MARSHALL ST
Mailing Address - Street 2:BOX 980163
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5051
Mailing Address - Country:US
Mailing Address - Phone:804-828-9955
Mailing Address - Fax:804-828-5775
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:BOX 980163
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-828-9955
Practice Address - Fax:804-828-5775
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101264809208M00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine