Provider Demographics
NPI:1700179678
Name:COHEN, NATALIE L (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:L
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3718
Mailing Address - Country:US
Mailing Address - Phone:978-635-8700
Mailing Address - Fax:978-635-8920
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3718
Practice Address - Country:US
Practice Address - Phone:978-635-8700
Practice Address - Fax:978-635-8920
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258083207R00000X
MI4301098231390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110099716AMedicaid