Provider Demographics
NPI:1538160981
Name:COHN, PETER B (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:B
Last Name:COHN
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 1:1350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1718
Mailing Address - Country:US
Mailing Address - Phone:508-668-2200
Mailing Address - Fax:508-668-6539
Practice Address - Street 1:1350 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1718
Practice Address - Country:US
Practice Address - Phone:508-668-2200
Practice Address - Fax:508-668-6539
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55772208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
55772OtherMEDICAL LICENSE
30446OtherCMSP/HSP
J05356OtherBCBS OF MA
84396OtherAETNA/US HEALTH CARE HMO
055772OtherTUFTS
7661058OtherCIGNA
P2772808OtherOXFORD
MA3007685Medicaid
20608OtherHPHC
4131924OtherAETNA/US HEALTH CARE
MA3007685Medicaid