1174554067 NPI number — KATHRYN L COHAN M.D.

Table of content: KATHRYN L COHAN M.D. (NPI 1174554067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174554067 NPI number — KATHRYN L COHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COHAN
Provider First Name:
KATHRYN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1174554067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 INDUSTRIAL RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01757-3588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-473-1480
Provider Business Mailing Address Fax Number:
508-473-1210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 UXBRIDGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENDON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01756-1094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-634-6620
Provider Business Practice Location Address Fax Number:
508-634-6813
Provider Enumeration Date:
07/06/2006

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: 207R00000X , with the licence number:  80055 , 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)

  • Identifier: 6197973 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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