Healthcare Provider Details

I. General information

NPI: 1730448150
Provider Name (Legal Business Name): DR. NATHAN TYLER COHEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW CHILDREN'S NATIONAL EMERGENCY MEDICAL AND TRAUMA CENTER
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW CHILDREN'S NATIONAL EMERGENCY MEDICAL AND TRAUMA CENTER
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-4177
  • Fax:
Mailing address:
  • Phone: 202-476-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101268703
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101268703
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD042964
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: