Healthcare Provider Details

I. General information

NPI: 1992818611
Provider Name (Legal Business Name): MICHAEL R COHAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BELMONT AVE ATT'N: MARILYN BOUDREAU
BRATTLEBORO VT
05301-6613
US

IV. Provider business mailing address

17 BELMONT AVE
BRATTLEBORO VT
05301-6613
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-8382
  • Fax: 802-251-8466
Mailing address:
  • Phone: 802-257-8382
  • Fax: 802-251-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number032-0000517
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: