Provider Demographics
NPI:1083604508
Name:COHAN, LAWRENCE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DAVID
Last Name:COHAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9124
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9124
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:10 HAWTHORNE PLACE
Practice Address - Street 2:SUITE 110 H 10 110
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-0924
Practice Address - Fax:617-724-3413
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA40296208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2061244Medicaid
MA703964OtherTUFTS HEALTH PLAN
MAM09733OtherBCBS MA
MAM09733OtherBCBS MA
E03287Medicare UPIN