Provider Demographics
NPI:1649249103
Name:COHN, CHARLES JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JACOB
Last Name:COHN
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:PO BOX 2688
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-2688
Mailing Address - Country:US
Mailing Address - Phone:843-546-0223
Mailing Address - Fax:843-545-0024
Practice Address - Street 1:1052A HUGER DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3322
Practice Address - Country:US
Practice Address - Phone:843-546-0223
Practice Address - Fax:843-545-0024
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13126207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC131262Medicaid
SC131262Medicaid
SCE622026312Medicare ID - Type Unspecified