MEDICARE: JEROME D COHEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	29623	MO

General Provider Information

NPI Number	:	1235147109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME D COHEN MD

Provider Business Mailing Address
First Line	:	8138 WESTMORELAND AVE
Second Line	:	PROVIDER ENROLLMENT
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-3731
Country	:	US
Telephone Number	:	314-721-2820
Fax Number	:

Provider Business Practice Location Address
First Line	:	8138 WESTMORELAND AVE
Second Line	:	PROVIDER ENROLLMENT
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-3731
Country	:	US
Telephone Number	:	314-721-2820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	04/16/2010

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