Provider Demographics
NPI:1023095494
Name:COHEN, ROBERT KENNETH (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W LANCASTER AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1762
Mailing Address - Country:US
Mailing Address - Phone:610-647-0400
Mailing Address - Fax:610-578-9590
Practice Address - Street 1:250 W LANCASTER AVE STE 225
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1762
Practice Address - Country:US
Practice Address - Phone:610-647-0400
Practice Address - Fax:610-578-9590
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004348-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01797431Medicaid
PA4687570001Medicare NSC
PA01797431Medicaid
PA031207Medicare ID - Type UnspecifiedMEDICARE SELF
PA066770Medicare ID - Type UnspecifiedDPM PC NUMBER