Provider Demographics
NPI:1538158068
Name:COHEN, EVAN BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:BRUCE
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 1:44 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2609
Mailing Address - Country:US
Mailing Address - Phone:401-274-4800
Mailing Address - Fax:401-454-0410
Practice Address - Street 1:44 W RIVER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-274-4800
Practice Address - Fax:401-454-0410
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6867207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406204OtherTUFTS
RI7000104Medicaid
RI1143OtherNEIGHBORHOOD HEALTH PLAN OF RI
RI303204OtherHARVARD PILGRIM
RI1143OtherNEIGHBORHOOD HEALTH PLAN OF RI
RID87246Medicare UPIN