Provider Demographics
NPI:1922000157
Name:COCHRAN, LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
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:PO BOX 37087
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3087
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:1021 COOLIDGE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4672
Practice Address - Country:US
Practice Address - Phone:423-636-8891
Practice Address - Fax:423-636-1732
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000004336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4147640OtherBCBS OF TN
TN0100OtherUNITED HEALTHCARE RIVER V
TN30850711Medicaid
3123351OtherBLUE CROSS PROVIDER NUMBE
080139991OtherRAILROAD MEDICARE
TN4147640OtherBCBS OF TN
3123351OtherBLUE CROSS PROVIDER NUMBE
TN30850711Medicaid