Provider Demographics
NPI:1760478333
Name:COHEN, VICTOR (DPM)
Entity Type:Individual
Prefix:
First Name:VICTOR
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 1:205 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1708
Mailing Address - Country:US
Mailing Address - Phone:717-761-6350
Mailing Address - Fax:717-761-6350
Practice Address - Street 1:205 GRANDVIEW AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1708
Practice Address - Country:US
Practice Address - Phone:717-761-6350
Practice Address - Fax:717-761-6350
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002973L213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA556567Medicare PIN
PAT84935Medicare UPIN
PA0182600001Medicare NSC