Provider Demographics
NPI:1831204494
Name:GARY A COHEN MD INC
Entity type:Organization
Organization Name:GARY A COHEN MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-458-0940
Mailing Address - Street 1:9833 PACIFIC HEIGHTS BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4707
Mailing Address - Country:US
Mailing Address - Phone:858-458-0940
Mailing Address - Fax:858-458-3688
Practice Address - Street 1:STE J
Practice Address - Street 2:9833 PACIFIC HEIGHTS BLVD
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4707
Practice Address - Country:US
Practice Address - Phone:858-458-0940
Practice Address - Fax:858-458-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43070207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG43070AMedicare PIN
CAW8746Medicare PIN