Provider Demographics
NPI:1578509055
Name:COCHRAN, ERIC T (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1741
Mailing Address - Country:US
Mailing Address - Phone:610-966-4646
Mailing Address - Fax:610-965-6201
Practice Address - Street 1:3760 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1741
Practice Address - Country:US
Practice Address - Phone:610-966-4646
Practice Address - Fax:610-965-6201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI26839Medicare UPIN
PA089275Medicare ID - Type UnspecifiedMEDICARE