Provider Demographics
NPI:1497769863
Name:COHEN, LAWRENCE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PORTAGE ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720
Mailing Address - Country:US
Mailing Address - Phone:330-494-4949
Mailing Address - Fax:330-494-4945
Practice Address - Street 1:1515 PORTAGE ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2290
Practice Address - Country:US
Practice Address - Phone:330-494-4949
Practice Address - Fax:330-494-4945
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1504213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0143964Medicaid
OH9301131OtherMEDICARE GROUP PTAN
U11666Medicare UPIN
OHCO0362023Medicare PIN
OH0143964Medicaid