Provider Demographics
NPI:1194802629
Name:COHEN, RICHARD D (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1336 BRISTOL PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5660
Mailing Address - Country:US
Mailing Address - Phone:215-638-3444
Mailing Address - Fax:215-638-3449
Practice Address - Street 1:1336 BRISTOL PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5660
Practice Address - Country:US
Practice Address - Phone:215-638-3444
Practice Address - Fax:215-638-3449
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA0S003656L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1570750Medicaid
G25088Medicare UPIN
PA1570750Medicaid