Basic Information
Provider Information | |||||||||
NPI: | 1427059005 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COCHRAN | ||||||||
FirstName: | MICHELLE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20 RESEARCH PL | ||||||||
Address2: | SUITE 320 | ||||||||
City: | NORTH CHELMSFORD | ||||||||
State: | MA | ||||||||
PostalCode: | 018632454 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9782561858 | ||||||||
FaxNumber: | 9787887890 | ||||||||
Practice Location | |||||||||
Address1: | 20 RESEARCH PL | ||||||||
Address2: | SUITE 320 | ||||||||
City: | NORTH CHELMSFORD | ||||||||
State: | MA | ||||||||
PostalCode: | 018632454 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9782561858 | ||||||||
FaxNumber: | 9787887890 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/09/2005 | ||||||||
LastUpdateDate: | 02/20/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | H28005 | MA | Y |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 0025775 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 1427059005 | 01 | MA | HEALTH PLANS INC | OTHER | 204926 | 01 | MA | MEDICAL LICENSE | OTHER | 1427059005 | 01 | MA | BMC HEALTH NET | OTHER | 65092 | 01 | MA | FALLON | OTHER | 978694 | 01 | MA | NETWORK | OTHER | J22976 | 01 | MA | BCBS | OTHER | 1427059005 | 01 | MA | CIGNA | OTHER | 1427059005 | 01 | MA | HEALTH PARTNERS | OTHER | 0122459 | 05 | MA |   | MEDICAID | 1427059005 | 01 | MA | GREAT WEST | OTHER | 204926 | 01 | MA | TUFTS | OTHER | 1427059005 | 01 | MA | CHAMPUS/TRICARE | OTHER | 2636922 | 01 | MA | ATHENA/US HEALTHCARE | OTHER | J22976 | 01 | MA | PREFERRED CARE NY | OTHER | 0005394 | 01 | MA | MEDICARE RAILROAD | OTHER | 1427059005 | 01 | MA | PREFERRED CARE NY | OTHER | AA116929 | 01 | MA | HPHC | OTHER |