Provider Demographics
NPI:1871561613
Name:COHEN, SIMON M (MD)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:M
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 63069
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:305-229-4311
Mailing Address - Fax:305-229-4388
Practice Address - Street 1:401 NW 42 AVE
Practice Address - Street 2:PLANTATION GENERAL HOSPITAL
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-587-5010
Practice Address - Fax:954-473-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030561207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94080OtherBLUE CROSS BLUE SHIELD
FL041511100Medicaid
FL041511100Medicaid
D63115Medicare UPIN