Provider Demographics
NPI:1164495016
Name:COTCH, DARREL L (PA)
Entity Type:Individual
Prefix:
First Name:DARREL
Middle Name:L
Last Name:COTCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1811 WEIR DRIVE
Mailing Address - Street 2:SUITE 355
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2273
Mailing Address - Country:US
Mailing Address - Phone:651-254-8580
Mailing Address - Fax:651-730-1700
Practice Address - Street 1:1811 WEIR DRIVE
Practice Address - Street 2:SUITE 355
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2273
Practice Address - Country:US
Practice Address - Phone:651-254-8580
Practice Address - Fax:651-730-1700
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN8914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN214341100Medicaid
P79595Medicare UPIN
MN970002135Medicare ID - Type Unspecified