Provider Demographics
NPI:1194764274
Name:COHEN, MICHAEL MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARTIN
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 1:1 BELMONT AVE
Mailing Address - Street 2:SUITE # 620 GSB BUILDING
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1617
Mailing Address - Country:US
Mailing Address - Phone:610-664-3888
Mailing Address - Fax:610-664-5254
Practice Address - Street 1:1 BELMONT AVE
Practice Address - Street 2:SUITE # 620 GSB BUILDING
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1617
Practice Address - Country:US
Practice Address - Phone:610-664-3888
Practice Address - Fax:610-664-5254
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-020509-E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD69994Medicare UPIN
PA066125Medicare ID - Type Unspecified