MEDICARE: DR. MICHAEL R COHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101040658	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306833199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R COHEN M.D.

Provider Business Mailing Address
First Line	:	8580 MAGELLAN PKWY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1149
Country	:	US
Telephone Number	:	804-733-8821
Fax Number	:	804-861-4365

Provider Business Practice Location Address
First Line	:	50 MEDICAL PARK BOULEVARD
Second Line	:	SUITE C & D
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9289
Country	:	US
Telephone Number	:	804-733-8821
Fax Number	:	804-861-4365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	02/05/2020

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