Provider Demographics
NPI:1457393332
Name:COHEN, GRETCHEN
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 HAYMAKER RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3518
Mailing Address - Country:US
Mailing Address - Phone:724-765-1031
Mailing Address - Fax:412-856-6079
Practice Address - Street 1:2580 HAYMAKER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3518
Practice Address - Country:US
Practice Address - Phone:724-765-1031
Practice Address - Fax:412-856-6079
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008035L176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010389420002Medicaid