Provider Demographics
NPI:1578676722
Name:NORTHSHORE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:NORTHSHORE INTERNAL MEDICINE
Other - Org Name:MAURI COHEN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-818-6110
Mailing Address - Street 1:PO BOX 2149
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-5149
Mailing Address - Country:US
Mailing Address - Phone:978-818-6110
Mailing Address - Fax:978-818-6115
Practice Address - Street 1:140 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3629
Practice Address - Country:US
Practice Address - Phone:978-750-0200
Practice Address - Fax:978-750-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty