Provider Demographics
NPI:1972517423
Name:COHEN, HARVEY DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:DONALD
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 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-987-2528
Mailing Address - Fax:909-398-1488
Practice Address - Street 1:8330 RED OAK ST STE 201
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0603
Practice Address - Country:US
Practice Address - Phone:909-987-2528
Practice Address - Fax:909-987-4668
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34367207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A343670Medicaid
CA00A343670Medicaid
CA00A343670Medicaid