Provider Demographics
NPI:1235130436
Name:COHEN, BRUCE ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLAN
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 1:1535 BOLLING AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1359
Mailing Address - Country:US
Mailing Address - Phone:850-206-3033
Mailing Address - Fax:
Practice Address - Street 1:MARINE FORCES COMMAND
Practice Address - Street 2:1775 FORRESTAL DRIVE
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23551-2596
Practice Address - Country:US
Practice Address - Phone:757-836-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026677E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine