Provider Demographics
NPI:1861482036
Name:COHEN, GEORGE LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LESLIE
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:151 MERRIMAC STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-227-5699
Mailing Address - Fax:617-227-4873
Practice Address - Street 1:151 MERRIMAC STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-227-5699
Practice Address - Fax:617-227-4873
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA29458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA713862OtherTUFTS HEALTH PLAN
MAM07253OtherBCBS MA
MA0116564Medicaid
MA713862OtherTUFTS HEALTH PLAN
MA0116564Medicaid