Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 258382 | MA |
N | 2080P0216X | Pediatric Rheumatologist | 258382 | MA |
NPI | 1144515818 |
---|---|
Provider Name | Ezra M. Cohen |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 05/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110100633A | (05) | MA |