Provider Demographics
NPI:1174863930
Name:COHEN, TOM (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:
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 1:105 CHURCH RD
Mailing Address - Street 2:RD#3
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-9329
Mailing Address - Country:US
Mailing Address - Phone:570-762-6649
Mailing Address - Fax:
Practice Address - Street 1:105 CHURCH RD
Practice Address - Street 2:RD#3
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-9329
Practice Address - Country:US
Practice Address - Phone:570-762-6649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025307E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine