1225033533 NPI number — MS. BETSY JANE COHEN FAAA

Table of content: MS. BETSY JANE COHEN FAAA (NPI 1225033533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225033533 NPI number — MS. BETSY JANE COHEN FAAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
BETSY
Provider Middle Name:
JANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FAAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225033533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 REVOLUTION ST
Provider Second Line Business Mailing Address:
HAVRE DE GRACE
Provider Business Mailing Address City Name:
HAVRE DE GRACE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21078-3718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-939-2030
Provider Business Mailing Address Fax Number:
410-939-2031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 REVOLUTION ST
Provider Second Line Business Practice Location Address:
HAVRE DE GRACE
Provider Business Practice Location Address City Name:
HAVRE DE GRACE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21078-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-939-2030
Provider Business Practice Location Address Fax Number:
410-939-2031
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  460 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0005749633 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 374948700 183421 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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