Provider Demographics
NPI:1548295892
Name:COHEN, SCOTT JASON (MD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JASON
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:600 BLAIR PARK RD STE 285
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7586
Mailing Address - Country:US
Mailing Address - Phone:802-288-1140
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:11 HAYDENBERRY DR UNIT 103
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-2200
Practice Address - Country:US
Practice Address - Phone:802-893-1200
Practice Address - Fax:802-893-2756
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG70317208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70317OtherMEDICAL LICENSE
CAG70317OtherMEDICAL #