Healthcare Provider Details

I. General information

NPI: 1558623777
Provider Name (Legal Business Name): COGENT HEALTHCARE OF BROCKTON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SOUTH ST
WARE MA
01082-1625
US

IV. Provider business mailing address

5410 MARYLAND WAY SUITE 300
BRENTWOOD TN
37027-5064
US

V. Phone/Fax

Practice location:
  • Phone: 615-377-5658
  • Fax:
Mailing address:
  • Phone: 615-377-1669
  • Fax: 615-246-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD GREENO
Title or Position: OWNER
Credential: MD
Phone: 949-399-6003