Healthcare Provider Details

I. General information

NPI: 1669441770
Provider Name (Legal Business Name): IRWIN COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 SITMAN AVENUE
GREENSBURG LA
70441
US

IV. Provider business mailing address

PO BOX 1207 490 SITMAN AVENUE
GREENSBURG LA
70441
US

V. Phone/Fax

Practice location:
  • Phone: 225-222-6059
  • Fax:
Mailing address:
  • Phone: 225-222-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3556R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: