Provider Demographics
NPI:1720123110
Name:COHEN, STUART MARC (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:MARC
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 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:SUITE #306
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-273-3014
Mailing Address - Fax:310-273-6956
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-273-3014
Practice Address - Fax:310-273-6956
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30359207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C303590Medicaid
A34233Medicare UPIN
CAC30359Medicare ID - Type Unspecified