Provider Demographics
NPI:1548268485
Name:COHEN, ROSS SAMUEL (DPM)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:SAMUEL
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8023 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7107
Mailing Address - Country:US
Mailing Address - Phone:410-761-4190
Mailing Address - Fax:410-761-0265
Practice Address - Street 1:8023 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7107
Practice Address - Country:US
Practice Address - Phone:410-761-4190
Practice Address - Fax:410-761-0265
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD480019706OtherRAILROAD MEDICARE
MDKT11 // 30736001OtherCAREFIRST BLUE SHIELD
MD358908100Medicaid
MDKT11OtherBLUE SHIELD NASCO
MD358668500Medicaid
MD521873415OtherTRICARE
MD480019706OtherFIRST HEALTH
MDT584 0001OtherBLUECHOICE
MD10227273OtherAMERIGROUP
MD228938OtherMDIPA/OPTIMUM CHOICE
MD5295711OtherAETNA
MD480019706OtherFIRST HEALTH
MD358668500Medicaid
MD0935510002Medicare NSC