Provider Demographics
NPI:1003801507
Name:COTTER, JOHN T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:COTTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 OREGON PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4670
Mailing Address - Country:US
Mailing Address - Phone:717-560-6470
Mailing Address - Fax:717-560-6472
Practice Address - Street 1:2207 OREGON PIKE STE 202
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4670
Practice Address - Country:US
Practice Address - Phone:717-560-6470
Practice Address - Fax:717-560-6472
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057310L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10925085Medicaid
PA10925085Medicaid
G23979Medicare UPIN