Healthcare Provider Details

I. General information

NPI: 1366890154
Provider Name (Legal Business Name): BRANDON COHEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 SAINT FRANCIS RD
TOWSON MD
21286-1435
US

IV. Provider business mailing address

602 SAINT FRANCIS RD
TOWSON MD
21286-1435
US

V. Phone/Fax

Practice location:
  • Phone: 410-499-6480
  • Fax:
Mailing address:
  • Phone: 410-499-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberH87731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: