Healthcare Provider Details

I. General information

NPI: 1417943978
Provider Name (Legal Business Name): RICHARD B COHEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 COULTER AVE
ARDMORE PA
19003-2427
US

IV. Provider business mailing address

119 COULTER AVE
ARDMORE PA
19003-2427
US

V. Phone/Fax

Practice location:
  • Phone: 610-649-6614
  • Fax:
Mailing address:
  • Phone: 610-832-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002122-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: