Provider Demographics
NPI:1669425872
Name:COHEN, CARLOS A (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:COHEN
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 1:16244 S. MILITARY TRAIL
Mailing Address - Street 2:SUITE 750
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:561-381-3443
Mailing Address - Fax:561-381-3441
Practice Address - Street 1:16244 S. MILITARY TRAIL
Practice Address - Street 2:SUITE 750
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-381-3443
Practice Address - Fax:561-381-3441
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075788207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255626000Medicaid
P00336029OtherRAILROAD MEDICARE
FL255626000Medicaid
E1156ZMedicare ID - Type Unspecified