Healthcare Provider Details

I. General information

NPI: 1841788387
Provider Name (Legal Business Name): SAMUEL J COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE # YACC6
BOSTON MA
02118-4001
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE FL 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5946
  • Fax: 617-414-4541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number286691
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: