Provider Demographics
NPI:1013174903
Name:COKONIS, CLARA D (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:D
Last Name:COKONIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CLARA-DINA
Other - Middle Name:
Other - Last Name:COKONIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:230 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5491
Mailing Address - Country:US
Mailing Address - Phone:781-431-5255
Mailing Address - Fax:781-431-5329
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5491
Practice Address - Country:US
Practice Address - Phone:781-431-5255
Practice Address - Fax:781-431-5329
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA080103207N00000X
MA239784207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083810AMedicaid
MA001305701Medicare PIN