Provider Demographics
NPI:1619902517
Name:COCHRAN, TERENCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:A
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SQUIRREL RUN
Mailing Address - Street 2:
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8960
Mailing Address - Country:US
Mailing Address - Phone:570-587-3703
Mailing Address - Fax:570-585-8135
Practice Address - Street 1:103 SQUIRREL RUN
Practice Address - Street 2:
Practice Address - City:CLARKS GREEN
Practice Address - State:PA
Practice Address - Zip Code:18411-8960
Practice Address - Country:US
Practice Address - Phone:570-587-3703
Practice Address - Fax:570-585-8132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016183E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA310011525440003Medicaid
PAIN595269Medicare ID - Type Unspecified