Basic Information
| Provider Information | |||||||||
| NPI: | 1548226319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MILES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 COMMERCIAL STREET | ||||||||
| Address2: | |||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026496507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084777090 | ||||||||
| FaxNumber: | 5084777028 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 COMMERCIAL STREET | ||||||||
| Address2: | COMMUNITY HEALTH CENTER OF CAPE COD, INC. | ||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026496507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084777090 | ||||||||
| FaxNumber: | 5084777028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 12/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 021541 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 234625 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004394532 | 05 | CT | MEDICAID |