Healthcare Provider Details

I. General information

NPI: 1932546058
Provider Name (Legal Business Name): BRIAN HARRIS COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST STE 200
PROVIDENCE RI
02905-3248
US

IV. Provider business mailing address

PO BOX 1119
PROVIDENCE RI
02901-1119
US

V. Phone/Fax

Practice location:
  • Phone: 401-443-4205
  • Fax: 401-831-8992
Mailing address:
  • Phone: 401-443-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberR-11467
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD16259
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: