Provider Demographics
NPI:1982771671
Name:COHEN, PETER J (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1830 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4275
Mailing Address - Country:US
Mailing Address - Phone:970-945-8503
Mailing Address - Fax:970-947-9048
Practice Address - Street 1:82 PETERBOROUGH ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-5860
Practice Address - Country:US
Practice Address - Phone:603-532-8775
Practice Address - Fax:603-532-7482
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0033906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01339068Medicaid
CO414376YSCSOtherPTAN