Provider Demographics
NPI:1083682272
Name:COTTEL, JILL S (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:S
Last Name:COTTEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CHISMAN LNDG
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:VA
Mailing Address - Zip Code:23696-2345
Mailing Address - Country:US
Mailing Address - Phone:858-361-1467
Mailing Address - Fax:
Practice Address - Street 1:1620 OLD WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23690-3910
Practice Address - Country:US
Practice Address - Phone:757-886-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA65247OtherSTATE LIC.
CAA65247OtherSTATE LIC.
CAG90536Medicare UPIN