Provider Demographics
NPI:1205055969
Name:COHEN-MCKEON, LEORA (DO)
Entity type:Individual
Prefix:DR
First Name:LEORA
Middle Name:
Last Name:COHEN-MCKEON
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 1:150 INFIRMARY WAY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9288
Mailing Address - Country:US
Mailing Address - Phone:413-577-5000
Mailing Address - Fax:413-577-5023
Practice Address - Street 1:150 INFIRMARY WAY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9288
Practice Address - Country:US
Practice Address - Phone:413-577-5000
Practice Address - Fax:413-577-5023
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241877207Q00000X
WAOL20000106207Q00000X
MEDO2397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400118690Medicare PIN