Healthcare Provider Details

I. General information

NPI: 1851462220
Provider Name (Legal Business Name): RONALD B COHEN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 BELPAR ST NW
CANTON OH
44718-3603
US

IV. Provider business mailing address

4760 BELPAR ST NW
CANTON OH
44718-3603
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-9200
  • Fax: 330-492-5454
Mailing address:
  • Phone: 330-492-9200
  • Fax: 330-492-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36002486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: