Healthcare Provider Details

I. General information

NPI: 1780638437
Provider Name (Legal Business Name): SETH COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MARKET CENTER DR STE A
FLAT ROCK NC
28731-8528
US

IV. Provider business mailing address

15 MARKET CENTER DR STE A
FLAT ROCK NC
28731-8529
US

V. Phone/Fax

Practice location:
  • Phone: 828-697-1170
  • Fax: 828-698-4939
Mailing address:
  • Phone: 828-697-1170
  • Fax: 828-698-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number33967
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: