Healthcare Provider Details

I. General information

NPI: 1538126552
Provider Name (Legal Business Name): RICHARD H COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 DUPONT CIR
LOUISVILLE KY
40207-4819
US

IV. Provider business mailing address

PO BOX 91345
LOUISVILLE KY
40291-0345
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-6428
  • Fax:
Mailing address:
  • Phone: 502-473-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number23373
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: