Provider Demographics
NPI:1124167119
Name:COHEN, PEGGY (LM)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8882
Mailing Address - Country:US
Mailing Address - Phone:802-879-1115
Mailing Address - Fax:
Practice Address - Street 1:2907 SOUTH RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8882
Practice Address - Country:US
Practice Address - Phone:802-879-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1070000004176B00000X
L-305240174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008583Medicaid
VT1008774Medicaid