MEDICARE: STEVEN B COHEN MD

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	207RG0100X	Gastroenterology Physician	76834	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	76834	OTHER	MA	TUFTS
2	66553	OTHER	MA	HPHC
3	J17482	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1740262286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN B COHEN MD

Provider Business Mailing Address
First Line	:	PO BOX 419
Second Line	:
City	:	LYNNFIELD
State	:	MA
Zip	:	01940-0419
Country	:	US
Telephone Number	:	781-444-6460
Fax Number	:	781-455-0169

Provider Business Practice Location Address
First Line	:	464 HILLSIDE AVE
Second Line	:	SUITE 201
City	:	NEEDHAM
State	:	MA
Zip	:	02494-1227
Country	:	US
Telephone Number	:	781-444-6460
Fax Number	:	781-455-0169

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	08/04/2015

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