Healthcare Provider Details

I. General information

NPI: 1629082458
Provider Name (Legal Business Name): ROBERT KOHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 GENERAL ST
PROVIDENCE RI
02904-1650
US

IV. Provider business mailing address

42 GENERAL ST
PROVIDENCE RI
02904-1650
US

V. Phone/Fax

Practice location:
  • Phone: 401-270-4649
  • Fax: 401-274-0656
Mailing address:
  • Phone: 401-270-4649
  • Fax: 401-274-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD07224
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD07224
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD07224
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: