Healthcare Provider Details

I. General information

NPI: 1235123647
Provider Name (Legal Business Name): COHEN & PUSHKIN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 SAINT PAUL STREET
BALTIMORE MD
21218
US

IV. Provider business mailing address

2506 SAINT PAUL STREET
BALTIMORE MD
21218
US

V. Phone/Fax

Practice location:
  • Phone: 410-235-3300
  • Fax: 410-366-1260
Mailing address:
  • Phone: 410-235-3300
  • Fax: 410-366-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD RALPH COHEN
Title or Position: PRESIDENT/PARTNER
Credential: M.D.
Phone: 410-235-3300