Provider Demographics
NPI:1497947733
Name:COHEN, BENJAMIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
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 1:1000 CLYBURN PL
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-4193
Mailing Address - Country:US
Mailing Address - Phone:803-380-7000
Mailing Address - Fax:803-502-4248
Practice Address - Street 1:1000 CLYBURN PL
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4193
Practice Address - Country:US
Practice Address - Phone:803-380-7000
Practice Address - Fax:803-502-4248
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3310213ES0103X
LADPM.200020213ES0103X
SC699213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery