Basic Information
| Provider Information | |||||||||
| NPI: | 1265429237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COCHRAN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., CAQG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3535 GRANGER RD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443331538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306663400 | ||||||||
| FaxNumber: | 3306655133 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 GRANGER RD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443331538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306663400 | ||||||||
| FaxNumber: | 3306655133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 08/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 35037907C | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000029166 | 01 | OH | ANTHEM | OTHER | 417 | 01 | OH | SUMMA | OTHER | 0731042 | 05 | OH | MEDICAID |