Healthcare Provider Details

I. General information

NPI: 1891783551
Provider Name (Legal Business Name): MICHAEL COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ONVILLE RD SUITE 205
STAFFORD VA
22556-3831
US

IV. Provider business mailing address

24 ONVILLE RD SUITE 205
STAFFORD VA
22556-3831
US

V. Phone/Fax

Practice location:
  • Phone: 540-658-0825
  • Fax: 540-658-0835
Mailing address:
  • Phone: 540-658-0825
  • Fax: 540-658-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101032992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: