Healthcare Provider Details

I. General information

NPI: 1538158068
Provider Name (Legal Business Name): EVAN BRUCE COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W RIVER ST
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

44 W RIVER ST
PROVIDENCE RI
02904-2609
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-4800
  • Fax: 401-454-0410
Mailing address:
  • Phone: 401-274-4800
  • Fax: 401-454-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number6867
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: