Healthcare Provider Details

I. General information

NPI: 1245523463
Provider Name (Legal Business Name): ERIC COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST SUITE 200
PROVIDENCE RI
02905-3236
US

IV. Provider business mailing address

PO BOX 1119
PROVIDENCE RI
02901-1119
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3581
  • Fax: 401-444-3609
Mailing address:
  • Phone: 401-444-3581
  • Fax: 401-444-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD15362
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: