Healthcare Provider Details

I. General information

NPI: 1033181276
Provider Name (Legal Business Name): DENNIS A COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 N LAKE DR
LEXINGTON SC
29072-7653
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-808-5050
  • Fax: 803-808-5059
Mailing address:
  • Phone: 803-296-7313
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7379
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: