Provider Demographics
NPI:1851482277
Name:COHEN, MAURICE B (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:B
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 1:52 STILES ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-898-5082
Mailing Address - Fax:603-890-5453
Practice Address - Street 1:NORTHEAST GASTROENTEROLOGY ASSOC., PC
Practice Address - Street 2:52 STILES ROAD SUITE 110
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-898-5082
Practice Address - Fax:603-890-5453
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60421207RG0100X
NH9119207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3044611Medicaid
MA9784594Medicaid
NH30006426Medicaid
NHRE4362Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
NH30006426Medicaid
E35288Medicare UPIN
MA3044611Medicaid
MA9784594Medicaid