Healthcare Provider Details

I. General information

NPI: 1487954046
Provider Name (Legal Business Name): MATTHEW T. COHAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE 416
CARMICHAEL CA
95608-6333
US

IV. Provider business mailing address

6620 COYLE AVE 416
CARMICHAEL CA
95608-6333
US

V. Phone/Fax

Practice location:
  • Phone: 916-965-6560
  • Fax: 916-965-5672
Mailing address:
  • Phone: 916-965-6560
  • Fax: 916-965-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0A41166
License Number StateCA

VIII. Authorized Official

Name: DR. MATTHEW T. COHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-965-6560