Healthcare Provider Details

I. General information

NPI: 1043583529
Provider Name (Legal Business Name): MARTIN HERBERT COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14609 CARONA DR
SILVER SPRING MD
20905-5888
US

IV. Provider business mailing address

14609 CARONA DR
SILVER SPRING MD
20905-5888
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-1344
  • Fax: 301-796-9845
Mailing address:
  • Phone: 301-796-1344
  • Fax: 301-796-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberDO2294
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: