Provider Demographics
NPI:1588744460
Name:COHAN, RICHARD HARRIS (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:HARRIS
Last Name:COHAN
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 1:12 STABLEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-3636
Mailing Address - Country:US
Mailing Address - Phone:845-363-1811
Mailing Address - Fax:
Practice Address - Street 1:12 STABLEVIEW LN
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-3636
Practice Address - Country:US
Practice Address - Phone:845-363-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1453172085B0100X
MI43010598462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H17609180Medicare ID - Type Unspecified
MI2852690Medicare ID - Type Unspecified
MID92983Medicare UPIN