Provider Demographics
NPI:1043289903
Name:COHAN, CHARLES FM (DO FACP)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:FM
Last Name:COHAN
Suffix:
Gender:M
Credentials:DO FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 EAST BROWN STREET
Mailing Address - Street 2:SUITE 115
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3098
Mailing Address - Country:US
Mailing Address - Phone:570-424-7764
Mailing Address - Fax:570-421-0760
Practice Address - Street 1:175 EAST BROWN STREET
Practice Address - Street 2:SUITE 115
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-424-7764
Practice Address - Fax:570-421-0760
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009950L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017380470001Medicaid
PA024098QDPMedicare ID - Type Unspecified
PA0017380470001Medicaid