Provider Demographics
NPI:1770661167
Name:COHEN, MABELLE H (MD)
Entity type:Individual
Prefix:DR
First Name:MABELLE
Middle Name:H
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-763-2100
Practice Address - Fax:717-975-2724
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV1329208G00000X, 208G00000X
CAA104459208G00000X, 208G00000X
PAMD462259208G00000X
WI3171208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1044590OtherBLUE SHIELD PROVIDER NUMBER
CA0A1044590OtherBLUE SHIELD PROVIDER NUMBER
CAFD009ZMedicare PIN
ILP01313557Medicare PIN
IL036133712Medicaid
IL969780012Medicare PIN
ILF400098477Medicare PIN