Provider Demographics
NPI:1093767857
Name:COHEN, MAURI ROGER (MD)
Entity Type:Individual
Prefix:
First Name:MAURI
Middle Name:ROGER
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 1:5 FEDERAL STREET
Mailing Address - Street 2:LAHEY HEALTH PRIMARY CARE, DANVERS
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-750-0200
Mailing Address - Fax:978-450-0220
Practice Address - Street 1:5 FEDERAL STREET
Practice Address - Street 2:LAHEY HEALTH PRIMARY CARE, DANVERS
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-750-0200
Practice Address - Fax:978-450-0220
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA49203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB97685Medicare UPIN
MAJ02031Medicare PIN