MEDICARE: DR. BRUCE ALLAN COHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD026677E	PA

General Provider Information

NPI Number	:	1235130436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ALLAN COHEN M.D.

Provider Business Mailing Address
First Line	:	1535 BOLLING AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-1359
Country	:	US
Telephone Number	:	850-206-3033
Fax Number	:

Provider Business Practice Location Address
First Line	:	MARINE FORCES COMMAND
Second Line	:	1775 FORRESTAL DRIVE
City	:	NORFOLK
State	:	VA
Zip	:	23551-2596
Country	:	US
Telephone Number	:	757-836-1682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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