Provider Demographics
NPI:1487954046
Name:MATTHEW T. COHAN, M.D., INC.
Entity type:Organization
Organization Name:MATTHEW T. COHAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:T
Authorized Official - Last Name:COHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-965-6560
Mailing Address - Street 1:6620 COYLE AVE
Mailing Address - Street 2:416
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6333
Mailing Address - Country:US
Mailing Address - Phone:916-965-6560
Mailing Address - Fax:916-965-5672
Practice Address - Street 1:6620 COYLE AVE
Practice Address - Street 2:416
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6333
Practice Address - Country:US
Practice Address - Phone:916-965-6560
Practice Address - Fax:916-965-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0A41166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A411660Medicaid