Provider Demographics
NPI:1487616025
Name:COHEN, SUSAN RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RUTH
Last Name:COHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:907 SUMNER ST
Mailing Address - Street 2:SUITE M-102
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3374
Mailing Address - Country:US
Mailing Address - Phone:781-344-3791
Mailing Address - Fax:781-341-3614
Practice Address - Street 1:907 SUMNER ST
Practice Address - Street 2:SUITE M-102
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3374
Practice Address - Country:US
Practice Address - Phone:781-344-3791
Practice Address - Fax:781-341-3614
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA71956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3089088Medicaid
F23965Medicare UPIN