MEDICARE: BERTRAM H COCHRAN MD INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35024257	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000165358	OTHER	OH	ANTHEM BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609191477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERTRAM H COCHRAN MD INC.

Provider Business Mailing Address
First Line	:	8224 MENTOR AVE
Second Line	:	SUITE 104
City	:	MENTOR
State	:	OH
Zip	:	44060-5768
Country	:	US
Telephone Number	:	440-255-3435
Fax Number	:	440-255-0181

Provider Business Practice Location Address
First Line	:	8224 MENTOR AVE
Second Line	:	SUITE 104
City	:	MENTOR
State	:	OH
Zip	:	44060-5768
Country	:	US
Telephone Number	:	440-255-3435
Fax Number	:	440-255-0181

Authorized Official
Title or Position	:	OWNER
Name	:	BERTRAM H COCHRAN
Credential	:	MD
Telephone Number	:	440-355-3435

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	04/05/2010

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