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General NPI Number Information
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NPI Number | 1124607247
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Entity Type | Individual
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Provider Name | BRYAN COCHRAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 33610 KING ST STE C, MAIL STOP 800499
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City | ALEXANDRIA
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State | VA
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Zip | 22314-0816
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Country | US
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Telephone | 703-845-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 KING ST STE C
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1908
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Country | US
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Telephone | 703-845-2812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101282499
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License Number State | VA
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