Healthcare Provider Details

I. General information

NPI: 1770755456
Provider Name (Legal Business Name): COHEN DERMATOPATHOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CRAWFORD STREET SUITE 100
NEEDHAM MA
02494
US

IV. Provider business mailing address

1111 S FREEPORT PKWY
COPPELL TX
75019-4435
US

V. Phone/Fax

Practice location:
  • Phone: 617-969-4100
  • Fax: 972-767-0126
Mailing address:
  • Phone: 866-588-3280
  • Fax: 972-767-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JIAN XIE
Title or Position: MANAGER
Credential:
Phone: 626-695-2199