Healthcare Provider Details

I. General information

NPI: 1255353397
Provider Name (Legal Business Name): INTEGRATED SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SQUIRREL RUN
CLARKS GREEN PA
18411-8960
US

IV. Provider business mailing address

103 SQUIRREL RUN
CLARKS GREEN PA
18411-8960
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-9336
  • Fax: 570-587-3703
Mailing address:
  • Phone: 570-346-9336
  • Fax: 570-587-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD016183E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0011525440003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. TERENCE COCHORAN
Title or Position: PRESIDENT
Credential: MD
Phone: 570-346-9336