Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | OS009950L | PA |
NPI | 1043289903 |
---|---|
Provider Name | Charles Fm Cohan |
First Address | East Stroudsburg, PA 18301-3098 |
Second Address | East Stroudsburg, PA 18301-3098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 12/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017380470001 | (05) | PA |
E70463 | (02) |