Provider Demographics
NPI:1942218896
Name:POCONO GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:POCONO GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:COHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-424-7764
Mailing Address - Street 1:175 EAST BROWN STREET
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3098
Mailing Address - Country:US
Mailing Address - Phone:570-424-7764
Mailing Address - Fax:570-421-0760
Practice Address - Street 1:175 EAST BROWN STREET
Practice Address - Street 2:SUITE 201A
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-424-7764
Practice Address - Fax:570-421-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009950L207RG0100X
PAMD042891L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA055730Medicare ID - Type Unspecified