Healthcare Provider Details

I. General information

NPI: 1548295892
Provider Name (Legal Business Name): SCOTT JASON COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HAYDENBERRY DR UNIT 103
MILTON VT
05468-2200
US

IV. Provider business mailing address

600 BLAIR PARK RD STE 285
WILLISTON VT
05495-7586
US

V. Phone/Fax

Practice location:
  • Phone: 802-893-1200
  • Fax: 802-893-2756
Mailing address:
  • Phone: 802-288-1140
  • Fax: 802-288-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG70317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: