Provider Demographics
NPI:1992769954
Name:COHEN, LANCE ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ADAM
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 1:22025 N 79TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4893
Mailing Address - Country:US
Mailing Address - Phone:480-563-4706
Mailing Address - Fax:480-563-4709
Practice Address - Street 1:20701 N SCOTTSDALE RD
Practice Address - Street 2:#107-499
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6413
Practice Address - Country:US
Practice Address - Phone:602-980-1009
Practice Address - Fax:480-563-4709
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3703234000OtherPASSPORT ADVANTAGE
102109OtherSIHO
KY7100073560Medicaid
000023036YOtherHUMANA ID
000000600845OtherANTHEM
KY00533097OtherMEDICARE
IN200937670Medicaid
50023051OtherPASSPORT PROVIDER ID