Healthcare Provider Details

I. General information

NPI: 1932369931
Provider Name (Legal Business Name): ELIZABETH COHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 10/17/2021
Certification Date: 10/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 CONSORT DR
BALLWIN MO
63011-4439
US

IV. Provider business mailing address

3030 TRAFALGAR DR
SAINT LOUIS MO
63131-2535
US

V. Phone/Fax

Practice location:
  • Phone: 636-386-9224
  • Fax:
Mailing address:
  • Phone: 314-637-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number2012009710
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2012009710
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: