Healthcare Provider Details

I. General information

NPI: 1255354742
Provider Name (Legal Business Name): STACEY KURTZ COHN M.D., FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW # M3400 GEORGETOWN UNIVERSITY HOSPITAL, DEPT. OF NEONATOLOGY
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

1609 WESTMORELAND ST
MCLEAN VA
22101-5166
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8569
  • Fax:
Mailing address:
  • Phone: 703-448-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD034820
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: