Provider Demographics
NPI:1689619371
Name:KOHEN, MENACHEM (MD)
Entity Type:Individual
Prefix:
First Name:MENACHEM
Middle Name:
Last Name:KOHEN
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 1:1 WATER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6221
Mailing Address - Country:US
Mailing Address - Phone:978-374-3940
Mailing Address - Fax:978-374-0257
Practice Address - Street 1:1 WATER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6221
Practice Address - Country:US
Practice Address - Phone:978-374-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3134083Medicaid
MA3134083Medicaid
F46110Medicare UPIN