Provider Demographics
NPI:1871699652
Name:COHEN, SCOTT D (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2475
Mailing Address - Country:US
Mailing Address - Phone:419-586-6899
Mailing Address - Fax:419-586-6799
Practice Address - Street 1:950 S MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2475
Practice Address - Country:US
Practice Address - Phone:419-586-6899
Practice Address - Fax:419-856-6799
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23460208800000X
IN01080881A208800000X
OH35091926208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN815500281OtherMEDICARE PTAN
IN300017108Medicaid
OH2844239Medicaid
SCT77556Medicaid
OHCO4244051Medicare PIN
SCT77556Medicaid