Individual
MERVYN D COHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, ROOM 1204A, INDIANAPOLIS, IN 46202-1239
(317) 962-5740
Mailing address
714 N SENATE AVE, STE EF205, INDIANAPOLIS, IN 46202-3763
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
01031346
IN
2085R0202X
Diagnostic Radiology Physician
01031346
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100349050
—
IN
01
—
300023464
RAILROAD MEDICARE
IN
Enumeration date
06/04/2006
Last updated
02/15/2011
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