Provider Demographics
NPI:1093710519
Name:COZEN, BENNETT H (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:H
Last Name:COZEN
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 1:1400 OLD YORK RD
Mailing Address - Street 2:STE A
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-2600
Mailing Address - Country:US
Mailing Address - Phone:215-576-1776
Mailing Address - Fax:
Practice Address - Street 1:1400 OLD YORK RD
Practice Address - Street 2:STE A
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-2600
Practice Address - Country:US
Practice Address - Phone:215-576-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033888E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA164196LV9Medicare PIN