Provider Demographics
NPI:1548283468
Name:COHEN, GREGORY D (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
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 1:13500 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3025
Mailing Address - Country:US
Mailing Address - Phone:310-231-9500
Mailing Address - Fax:310-231-9230
Practice Address - Street 1:13500 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3025
Practice Address - Country:US
Practice Address - Phone:310-231-9500
Practice Address - Fax:310-231-9230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73635207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G736350OtherMEDICAL PPIN #
CAWG73635EMedicare ID - Type UnspecifiedPPIN #
CAG00580Medicare UPIN
CAWG73635CMedicare ID - Type UnspecifiedPPIN #
CAWG73635DMedicare ID - Type UnspecifiedPPIN #
CA00G736350OtherMEDICAL PPIN #
CAWG73635BMedicare ID - Type UnspecifiedPPIN #