Provider Demographics
NPI:1609191477
Name:BERTRAM H COCHRAN MD INC.
Entity Type:Organization
Organization Name:BERTRAM H COCHRAN MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERTRAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-355-3435
Mailing Address - Street 1:8224 MENTOR AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5768
Mailing Address - Country:US
Mailing Address - Phone:440-255-3435
Mailing Address - Fax:440-255-0181
Practice Address - Street 1:8224 MENTOR AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5768
Practice Address - Country:US
Practice Address - Phone:440-255-3435
Practice Address - Fax:440-255-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35024257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000165358OtherANTHEM BLUE CROSS BLUE SHIELD
OH0058342Medicaid
OH000000165358OtherANTHEM BLUE CROSS BLUE SHIELD
OH0058342Medicaid