Provider Demographics
NPI:1780684787
Name:COHEN, LARRY KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:KENNETH
Last Name:COHEN
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 1:470 COLUMBIA DR
Mailing Address - Street 2:SUITE A102
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1997
Mailing Address - Country:US
Mailing Address - Phone:561-640-4000
Mailing Address - Fax:561-640-8098
Practice Address - Street 1:470 COLUMBIA DR
Practice Address - Street 2:SUITE A102
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1997
Practice Address - Country:US
Practice Address - Phone:561-640-4000
Practice Address - Fax:561-640-8098
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87633207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
003652E59Medicare ID - Type Unspecified
C26098Medicare UPIN