Healthcare Provider Details

I. General information

NPI: 1962478008
Provider Name (Legal Business Name): JEFFREY P COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST
CHARLTON MA
01507-1590
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 508-248-3015
  • Fax: 508-248-4734
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75592
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: