Provider Demographics
NPI:1881656270
Name:COS, LOUIS ROBERT (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:ROBERT
Last Name:COS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:ROBERTO
Other - Last Name:COS-SOTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:990 SOUTH AVENUE
Mailing Address - Street 2:#208
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-244-3080
Mailing Address - Fax:585-244-5491
Practice Address - Street 1:990 SOUTH AVENUE
Practice Address - Street 2:#208
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-244-3080
Practice Address - Fax:585-244-5491
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1389391208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903237Medicaid
NYB76270Medicare ID - Type Unspecified
NY00903237Medicaid