Healthcare Provider Details

I. General information

NPI: 1598756231
Provider Name (Legal Business Name): GLENN R COHEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W GERMANTOWN PIKE SUITE 2
EAST NORRITON PA
19401-1382
US

IV. Provider business mailing address

123 W GERMANTOWN PIKE SUITE 2
EAST NORRITON PA
19401-1382
US

V. Phone/Fax

Practice location:
  • Phone: 610-278-7456
  • Fax: 610-278-7457
Mailing address:
  • Phone: 610-278-7456
  • Fax: 610-278-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number012264
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: