Bethany R. Cohen, M.D.
Individual provider Active NPI Family Medicine Physician · Notre Dame, IN
NPI 1073808705 · NPPES record last updated Oct 26, 2022
Key facts
- NPI
- 1073808705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 01071880A (IN)
- Practice address
- 107 St Liam Hall
Notre Dame, IN 46556-5693 - Phone
- (574) 631-7497
- Fax
- (574) 631-6047
- NPI assigned
- Jun 10, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01071880A | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Regional Medical Center, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01071880A | IN | Yes |
Addresses
Primary practice location
107 St Liam Hall
Notre Dame, IN 46556-5693
Mailing address
107 St Liam Hall
Notre Dame, IN 46556-5693
Phone (574) 631-7497
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201110970 | Medicaid | IN |
Other providers in Notre Dame, IN
- Willard Agnew III
- Julie Bennington
- Katie Bourbonnais
- Kathryn Marie Cox Cohoon
- Chelsey Delgado
- Elizabeth Anne Fourman
- Benjamin Garman
- Jamie Garvey
All providers in Notre Dame, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.