Provider Demographics
NPI:1346228087
Name:COTTER, PHILIP D (PHD, FACMG)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:D
Last Name:COTTER
Suffix:
Gender:M
Credentials:PHD, FACMG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MASON LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2552
Mailing Address - Country:US
Mailing Address - Phone:949-812-7363
Mailing Address - Fax:
Practice Address - Street 1:5 MASON LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2552
Practice Address - Country:US
Practice Address - Phone:949-812-6902
Practice Address - Fax:949-297-3983
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADRM1207SC0300X
CADRN1207SG0203X
CADRM00000001207SC0300X, 207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics