Provider Demographics
NPI:1356360655
Name:COHEN, MATTHEW S (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 MILL RIDGE CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-5900
Mailing Address - Country:US
Mailing Address - Phone:605-593-6408
Mailing Address - Fax:440-329-5814
Practice Address - Street 1:630 EAST RIVER STREET ELYRIA
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-329-7450
Practice Address - Fax:440-329-5814
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34101583207Q00000X
IN02003160A207Q00000X
SD7261208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1356360655OtherWELLMARK
SD7302250Medicaid
SDS102600Medicare PIN