=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487698320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD COHEN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 08/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4445 TALBOT RD S
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-6219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-690-3414
-----------------------------------------------------
Fax | 425-690-9414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3600 LIND AVE SW SUITE 100 ATTN CREDENTIALING
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-4970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-690-2715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD00024549
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------