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General NPI Number Information
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NPI Number | 1477517548
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Entity Type | Individual
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Provider Name | MIRIAM SUSAN COHEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 04/23/2017
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Provider Practice Location Address
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Address Line | 97 BARNES RD STE 6
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City | WALLINGFORD
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State | CT
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Zip | 06492-1885
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Country | US
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Telephone | 203-753-6776
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Fax | 203-573-1875
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Provider Business Mailing Address
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Address Line | 195 BEAR PATH RD
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City | HAMDEN
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State | CT
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Zip | 06514-1342
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Country | US
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Telephone | 203-407-0161
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 040590
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License Number State | CT
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