Provider Demographics
NPI:1528067063
Name:COHN, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:COHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-4820
Mailing Address - Fax:802-371-4855
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:MOB-C, STE 1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-371-4820
Practice Address - Fax:802-371-4855
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY24793208800000X
VT042.0012910208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000045849OtherANTHEM
KY340008093OtherRAILROAD MEDICARE
KY1048729OtherPASSPORT
KY64247935Medicaid
VT1023136Medicaid
VTY400150328OtherMEDICARE PTAN LINKED TO CVMC MGP
KY1048729OtherPASSPORT
KYB96377Medicare UPIN