Healthcare Provider Details

I. General information

NPI: 1639146939
Provider Name (Legal Business Name): ROGER B COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BOULEVARD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BOULEVARD
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-5858
  • Fax: 215-349-8144
Mailing address:
  • Phone: 215-615-5858
  • Fax: 215-349-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD073307L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD073307L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: