Provider Demographics
NPI:1568401610
Name:COCHRAN, DANIEL C (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:17385 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-665-5996
Practice Address - Fax:757-665-5973
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010113L207Q00000X
VA0102202590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH37565Medicare UPIN