Provider Demographics
NPI:1528146164
Name:COHEN, FRED (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
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 1:3370 BURNS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4327
Mailing Address - Country:US
Mailing Address - Phone:561-627-7855
Mailing Address - Fax:561-627-5030
Practice Address - Street 1:3370 BURNS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4327
Practice Address - Country:US
Practice Address - Phone:561-627-7855
Practice Address - Fax:561-627-5030
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014329207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC58763Medicare UPIN
FL61191Medicare ID - Type Unspecified