Basic Information
| Provider Information | |||||||||
| NPI: | 1497971642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAROLD L. COHEN, M.D., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 W 2ND ST | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474032212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123321401 | ||||||||
| FaxNumber: | 8123323062 | ||||||||
| Practice Location | |||||||||
| Address1: | 2160 E STATE HIGHWAY 54 | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474419407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128478615 | ||||||||
| FaxNumber: | 8128478616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | LANE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8128478615 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 01060284A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 200519570 | 05 | IN | MEDICAID |