Provider Demographics
NPI:1013992957
Name:COHEN, LARRY WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WARREN
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 1:41 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-7037
Mailing Address - Fax:
Practice Address - Street 1:14425 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1177
Practice Address - Country:US
Practice Address - Phone:215-464-9599
Practice Address - Fax:215-464-7865
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026348E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D71602Medicare UPIN
PA412587Medicare ID - Type Unspecified
412587JLTMedicare PIN