Healthcare Provider Details

I. General information

NPI: 1639108384
Provider Name (Legal Business Name): ANDREW J. COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST APC 9
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

PO BOX 1358
PROVIDENCE RI
02901-1358
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5445
  • Fax: 401-444-8453
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD12560
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: