MEDICARE: MR. PHILIP MOSES COHEN PA-C

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	363AS0400X	Surgical Physician Assistant	0110840565	VA
2	363AS0400X	Surgical Physician Assistant	C01921	MD
3	363A00000X	Physician Assistant	C01921	MD

General Provider Information

NPI Number	:	1306884671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP MOSES COHEN PA-C

Provider Business Mailing Address
First Line	:	1015 18TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-5203
Country	:	US
Telephone Number	:	301-896-9792
Fax Number	:

Provider Business Practice Location Address
First Line	:	20410 OBSERVATION DR STE 103
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-6419
Country	:	US
Telephone Number	:	202-835-2222
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	06/03/2021

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