Healthcare Provider Details

I. General information

NPI: 1609868165
Provider Name (Legal Business Name): MELVIN LEE COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 N US HIGHWAY 281 SUITE 110
SAN ANTONIO TX
78232-3733
US

IV. Provider business mailing address

13722 CAPE BLF
SAN ANTONIO TX
78216-1605
US

V. Phone/Fax

Practice location:
  • Phone: 210-490-9850
  • Fax: 210-490-1465
Mailing address:
  • Phone: 210-490-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE8397
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberE8397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: