Provider Demographics
NPI:1477522910
Name:COHEN DERMATOPATHOLOGY, P.C.
Entity Type:Organization
Organization Name:COHEN DERMATOPATHOLOGY, P.C.
Other - Org Name:INFORM DIAGNOSTICS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP, COMPLIANCE, ETHICS & QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:SIMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-277-8700
Mailing Address - Street 1:6655 N MACARTHUR BLVD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2443
Mailing Address - Country:US
Mailing Address - Phone:214-596-7031
Mailing Address - Fax:
Practice Address - Street 1:15 CRAWFORD STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494
Practice Address - Country:US
Practice Address - Phone:617-969-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2663207ND0900X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00069006OtherRAILROAD MEDICARE PROV NO
MATR0064Medicare PIN
MAP00069006OtherRAILROAD MEDICARE PROV NO
MATR0064Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
MA9787194Medicaid
MA690074OtherTUFTS HEALTH PLAN PROV NO
MA262265OtherFALLON HEALTH PLAN PROV N
MA800887OtherHARVARD PILGRIM PROV NO
MAM17162OtherBC/BS OF MA PROV NO