1144325424 NPI number — MRS. KERRY ANN COHEN AUD

Table of content: MRS. KERRY ANN COHEN AUD (NPI 1144325424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144325424 NPI number — MRS. KERRY ANN COHEN AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHEN
Provider First Name:
KERRY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAGEMANN
Provider Other First Name:
KERRY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144325424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 CARLTON STREET
Provider Second Line Business Mailing Address:
593 ADERHOLD HALL
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30602-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-542-4598
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1244 BOYLSTON ST
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
CHESTNUT HILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-383-6800
Provider Business Practice Location Address Fax Number:
617-383-6801
Provider Enumeration Date:
09/13/2006

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:  835 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com