Provider Demographics
NPI:1740262286
Name:COHEN, STEVEN B (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-0419
Mailing Address - Country:US
Mailing Address - Phone:781-444-6460
Mailing Address - Fax:781-455-0169
Practice Address - Street 1:464 HILLSIDE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1227
Practice Address - Country:US
Practice Address - Phone:781-444-6460
Practice Address - Fax:781-455-0169
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76834207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA76834OtherTUFTS
MA66553OtherHPHC
MAJ17482OtherBCBS
MAM21892Medicare PIN
MA76834OtherTUFTS
MA3176371Medicaid