Provider Demographics
NPI:1891783551
Name:COHEN, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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 1:24 ONVILLE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3831
Mailing Address - Country:US
Mailing Address - Phone:540-658-0825
Mailing Address - Fax:540-658-0835
Practice Address - Street 1:24 ONVILLE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3831
Practice Address - Country:US
Practice Address - Phone:540-658-0825
Practice Address - Fax:540-658-0835
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30860001OtherCAREFIRST BC BS
VA005804086Medicaid
VA372340481OtherHEALTHNET
VA285621OtherANTHEM BC BS
VA005804086Medicaid
VA110007878Medicare ID - Type Unspecified