Provider Demographics
NPI:1306895172
Name:COHEN, MICHAEL BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 THORNDIKE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2717
Mailing Address - Country:US
Mailing Address - Phone:617-591-9494
Mailing Address - Fax:617-591-9494
Practice Address - Street 1:30 NEW CROSSING RD STE 310
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3271
Practice Address - Country:US
Practice Address - Phone:781-944-1228
Practice Address - Fax:781-944-1168
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70992207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAEO1939Medicare UPIN