Provider Demographics
NPI:1952360190
Name:COHEN, FREDRIC L (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:L
Last Name:COHEN
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 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:799 GAY ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4409
Practice Address - Country:US
Practice Address - Phone:610-935-0644
Practice Address - Fax:610-935-7757
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-022211-E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008864010002Medicaid
PA0052773000OtherKEYSTONE HEALTH PLAN EAST
PA30018349OtherKEYSTONE MERCY
PA3716816OtherAETNA
PA46643OtherHIGHMARK BLUE SHIELD
PA0052773000OtherPERSONAL CHOICE
PA0052773000OtherKEYSTONE HEALTH PLAN EAST
PA0008864010002Medicaid