Healthcare Provider Details

I. General information

NPI: 1043289903
Provider Name (Legal Business Name): CHARLES FM COHAN DO FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 ROUTE 611 STE 300
BARTONSVILLE PA
18321-7800
US

IV. Provider business mailing address

701 OSTRUM ST
FOUNTAIN HILL PA
18015-1155
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-6545
  • Fax:
Mailing address:
  • Phone: 866-785-8537
  • Fax: 866-785-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS009950L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: