Provider Demographics
NPI:1053283267
Name:COCHRAN, MARIO THOMAS SR
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:THOMAS
Last Name:COCHRAN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7042 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-2747
Mailing Address - Country:US
Mailing Address - Phone:937-718-8279
Mailing Address - Fax:
Practice Address - Street 1:303 KINSEY RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1410
Practice Address - Country:US
Practice Address - Phone:937-718-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator