Provider Demographics
NPI:1962479576
Name:COHEN, JILL B (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:B
Last Name:COHEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W LANCASTER AVE MOB 2 STE 120
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1755
Mailing Address - Country:US
Mailing Address - Phone:610-644-9456
Mailing Address - Fax:610-644-5203
Practice Address - Street 1:255 W LANCASTER AVE MOB 2 STE 120
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1755
Practice Address - Country:US
Practice Address - Phone:610-644-9456
Practice Address - Fax:610-644-5203
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008368L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56773Medicare UPIN
PA000216PZ6Medicare ID - Type Unspecified