MEDICARE: JEFFREY R COHEN D.O.

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	34-00-2836	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447259353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY R COHEN D.O.

Provider Business Mailing Address
First Line	:	132 N MARKET ST
Second Line	:
City	:	EAST PALESTINE
State	:	OH
Zip	:	44413-2019
Country	:	US
Telephone Number	:	330-426-9484
Fax Number	:	330-426-2248

Provider Business Practice Location Address
First Line	:	132 N MARKET ST
Second Line	:
City	:	EAST PALESTINE
State	:	OH
Zip	:	44413-2019
Country	:	US
Telephone Number	:	330-426-9484
Fax Number	:	330-426-2248

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	06/02/2010

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