Basic Information
| Provider Information | |||||||||
| NPI: | 1487685731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1344 WINTERGREEN LN NE UNIT 100 | ||||||||
| Address2: | |||||||||
| City: | BAINBRIDGE ISLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981105147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062010488 | ||||||||
| FaxNumber: | 3607446270 | ||||||||
| Practice Location | |||||||||
| Address1: | 1344 WINTERGREEN LN NE UNIT 100 | ||||||||
| Address2: | |||||||||
| City: | BAINBRIDGE ISLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981105147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062010488 | ||||||||
| FaxNumber: | 3607446270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60796621 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2090000 | 05 | WA | MEDICAID |