Healthcare Provider Details

I. General information

NPI: 1962509489
Provider Name (Legal Business Name): CHARLES P COCHRAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MAIN AVE SUITE 201
NORWALK CT
06851-1080
US

IV. Provider business mailing address

761 MAIN AVE SUITE 201
NORWALK CT
06851-1080
US

V. Phone/Fax

Practice location:
  • Phone: 203-838-4000
  • Fax: 203-845-9535
Mailing address:
  • Phone: 203-838-4000
  • Fax: 203-845-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number029822
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number029822
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: