Provider Demographics
NPI:1255353397
Name:INTEGRATED SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:INTEGRATED SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-346-9336
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:570-346-9336
Mailing Address - Fax:570-587-3703
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:570-346-9336
Practice Address - Fax:570-587-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016183E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011525440003Medicaid
PA0011525440003Medicaid