Provider Demographics
NPI:1548249618
Name:COHEN, HAROLD LANE (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LANE
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 1:1017 WETHERSFIELD XING
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8719
Mailing Address - Country:US
Mailing Address - Phone:812-606-2291
Mailing Address - Fax:
Practice Address - Street 1:1017 WETHERSFIELD XING
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8719
Practice Address - Country:US
Practice Address - Phone:812-606-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35130815207W00000X
IN01060284A207W00000X
WV26937207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1548249618Medicaid
OH0167380Medicaid
WV3810021966OtherGROUP MEDICAID
WV1548249618Medicaid
OH0167380Medicaid
WVWV6571C410Medicare PIN
ING54190Medicare UPIN
OH0167380Medicaid
IN227050AMedicare PIN
ININ1942002Medicare PIN