Provider Demographics
NPI:1467473298
Name:KOCHAN, CHARLES EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:KOCHAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 415126
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:203-384-3975
Mailing Address - Fax:203-384-3829
Practice Address - Street 1:226 MILL HILL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2826
Practice Address - Country:US
Practice Address - Phone:203-384-3394
Practice Address - Fax:203-384-3829
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20886207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001208867Medicaid
CTD02539Medicare UPIN
110000974Medicare ID - Type Unspecified