Provider Demographics
NPI:1962524702
Name:COHEN, STEPHEN (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 ANNAPOLIS MALL
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3090
Mailing Address - Country:US
Mailing Address - Phone:410-573-2095
Mailing Address - Fax:
Practice Address - Street 1:1505 ANNAPOLIS MALL
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3090
Practice Address - Country:US
Practice Address - Phone:410-573-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD625QMedicare ID - Type Unspecified
U58339Medicare UPIN