Healthcare Provider Details

I. General information

NPI: 1053949560
Provider Name (Legal Business Name): BENJAMIN THOMAS COCANOUGHER MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 4006
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

2301 ERWIN RD
DURHAM NC
27705-4699
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4760
  • Fax: 513-636-7297
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number35.152910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: