Provider Demographics
NPI:1184895716
Name:COHEN, FREDRIC J (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:J
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 1:13 SUMMIT SQUARE CTR
Mailing Address - Street 2:#132
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1078
Mailing Address - Country:US
Mailing Address - Phone:215-860-3336
Mailing Address - Fax:
Practice Address - Street 1:13 SUMMIT SQUARE CTR
Practice Address - Street 2:#132
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1078
Practice Address - Country:US
Practice Address - Phone:215-860-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-071124-L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF33045Medicare UPIN