Healthcare Provider Details

I. General information

NPI: 1447638085
Provider Name (Legal Business Name): PAUL COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860
US

IV. Provider business mailing address

3073 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-7101
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-5461
  • Fax:
Mailing address:
  • Phone: 603-356-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301107169
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301107169
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18944
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: