Provider Demographics
NPI:1104803204
Name:COHN, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:COHN
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 1:728 134TH ST SW
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5322
Mailing Address - Country:US
Mailing Address - Phone:425-297-6200
Mailing Address - Fax:425-297-6250
Practice Address - Street 1:728 134TH ST SW
Practice Address - Street 2:SUITE # 120
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5322
Practice Address - Country:US
Practice Address - Phone:425-297-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000182132085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115846OtherL&I
WA155069OtherL&I NUMBER
WA8132840Medicaid
WA8132840Medicaid
WA155069OtherL&I NUMBER
WAAB25177Medicare ID - Type UnspecifiedPROVIDER NUMBER
WAA09342Medicare UPIN