Provider Demographics
NPI:1043380173
Name:COHEN, HERBERT E (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:E
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:G4280 THOS JEFF UNIV HOSP
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-4178
Mailing Address - Fax:215-955-8509
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:G4280 THOS JEFF UNIV HOSP
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-4178
Practice Address - Fax:215-955-8509
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD006825E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA147259Medicare PIN
PAC27517Medicare UPIN