Healthcare Provider Details

I. General information

NPI: 1538160981
Provider Name (Legal Business Name): PETER B COHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MAIN ST
WALPOLE MA
02081-1718
US

IV. Provider business mailing address

1350 MAIN ST
WALPOLE MA
02081-1718
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-2200
  • Fax: 508-668-6539
Mailing address:
  • Phone: 508-668-2200
  • Fax: 508-668-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55772
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier55772
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICAL LICENSE
# 2
Identifier30446
Identifier TypeOTHER
Identifier State
Identifier IssuerCMSP/HSP
# 3
IdentifierJ05356
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS OF MA
# 4
Identifier84396
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA/US HEALTH CARE HMO
# 5
Identifier055772
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS
# 6
Identifier7661058
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 7
IdentifierP2772808
Identifier TypeOTHER
Identifier State
Identifier IssuerOXFORD
# 8
Identifier3007685
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 9
Identifier20608
Identifier TypeOTHER
Identifier State
Identifier IssuerHPHC
# 10
Identifier4131924
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA/US HEALTH CARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: