Healthcare Provider Details

I. General information

NPI: 1285741801
Provider Name (Legal Business Name): MARIO COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N MAIN ST SUITE 201
W HARTFORD CT
06117
US

IV. Provider business mailing address

345 N MAIN ST SUITE 201
W HARTFORD CT
06117
US

V. Phone/Fax

Practice location:
  • Phone: 860-561-7222
  • Fax: 860-561-7228
Mailing address:
  • Phone: 860-561-7222
  • Fax: 860-561-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number028179
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: