Provider Demographics
NPI:1962478008
Name:COHEN, JEFFREY P (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
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 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-949-6880
Mailing Address - Fax:508-949-6742
Practice Address - Street 1:340 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570
Practice Address - Country:US
Practice Address - Phone:508-949-6880
Practice Address - Fax:508-949-6742
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
26722OtherCHILDRENS MED SECURITY
7522604OtherAETNA US HEALTHCARE
J12596OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
043058466OtherTRICARE CHAMPUS
784236OtherMVP HEALTH CARE
0100249OtherEVERCARE
042472266OtherUNITED HEALTHCARE
042472266OtherTHREE RIVERS
2973114OtherCIGNA HEALTH PLAN
9900891OtherFALLON COMM HEALTH PLAN
J12596OtherBLUE CARE ELECT
406057OtherTUFTS HEALTH PLAN
AA1280OtherHARVARD PILGRIM
J12596OtherBLUE SHIELD INDEMNITY
26722OtherHEALTHY START
MA3100235Medicaid
917599OtherFIRST HEALTH
26722OtherHEALTHY START
7522604OtherAETNA US HEALTHCARE