Provider Demographics
NPI:1124091236
Name:COHEN, EDITH J (MD)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:J
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-464-6944
Practice Address - Fax:757-464-6952
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherTRICARE
VA437341OtherANTHEM
VA541595397OtherMID ATLANTIC SOLUTIONS
VA68652OtherSENTARA/OPTIMA
VA541595397OtherAETNA
VA005881196Medicaid
VA541595397OtherCIGNA
VA541595397OtherVIRGINIA HEALTH NETWORK
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA541595397OtherTRICARE
VAH37341Medicare UPIN