Provider Demographics
NPI:1285018739
Name:NETTOC MEDICAL GROUP
Entity Type:Organization
Organization Name:NETTOC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:COTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-671-5273
Mailing Address - Street 1:3661 SUNSET AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3411
Mailing Address - Country:US
Mailing Address - Phone:888-671-5273
Mailing Address - Fax:800-604-5503
Practice Address - Street 1:3661 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3411
Practice Address - Country:US
Practice Address - Phone:888-671-5273
Practice Address - Fax:800-604-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D2100159OtherCLIA
NC34D2100159OtherCLIA