Provider Demographics
NPI:1891034559
Name:COHEN, CHARLES SAMUEL (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:SAMUEL
Last Name:COHEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-6107
Mailing Address - Country:US
Mailing Address - Phone:207-706-5030
Mailing Address - Fax:877-343-6641
Practice Address - Street 1:195 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-6107
Practice Address - Country:US
Practice Address - Phone:207-706-5030
Practice Address - Fax:877-343-6641
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4614363A00000X
MEPA1695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant