Provider Demographics
NPI:1811076755
Name:COHEN, PAMELA E (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:E
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 1:700 MCELWEE RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3936
Mailing Address - Country:US
Mailing Address - Phone:856-235-4828
Mailing Address - Fax:856-642-0238
Practice Address - Street 1:3111 ROUTE 38 STE 11
Practice Address - Street 2:PMB 120
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9762
Practice Address - Country:US
Practice Address - Phone:856-235-4828
Practice Address - Fax:856-642-0238
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04900000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
2211221000OtherAMERIHEALTH/KEYSTONE/PC
NJ583634Medicare ID - Type UnspecifiedMEDICARE NJ NORTH
2211221000OtherAMERIHEALTH/KEYSTONE/PC