MEDICARE: DR. STEVEN IRA COHEN M.D.

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	208600000X	Surgery Physician	RI5011	RI

General Provider Information

NPI Number	:	1245220268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN IRA COHEN M.D.

Provider Business Mailing Address
First Line	:	528 N MAIN ST
Second Line	:	SUITE 3
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-5762
Country	:	US
Telephone Number	:	401-421-3306
Fax Number	:	401-421-3307

Provider Business Practice Location Address
First Line	:	528 N MAIN ST
Second Line	:	SUITE 3
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-5762
Country	:	US
Telephone Number	:	401-421-3306
Fax Number	:	401-421-3307

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/03/2008

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