Healthcare Provider Details

I. General information

NPI: 1245220268
Provider Name (Legal Business Name): STEVEN IRA COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 N MAIN ST SUITE 3
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

528 N MAIN ST SUITE 3
PROVIDENCE RI
02904-5762
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-3306
  • Fax: 401-421-3307
Mailing address:
  • Phone: 401-421-3306
  • Fax: 401-421-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRI5011
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: