Provider Demographics
NPI:1104358514
Name:COCHRAN, TIFFANY M (M D)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PORT ROYAL MEDICAL CENTER
Mailing Address - Street 2:1320 RIBAUT ROAD
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935
Mailing Address - Country:US
Mailing Address - Phone:843-987-7400
Mailing Address - Fax:
Practice Address - Street 1:721 OKATIE HWY 170
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-3963
Practice Address - Country:US
Practice Address - Phone:843-986-0900
Practice Address - Fax:843-986-0566
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138771207R00000X
GA390200000X
SCMD-88674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program