Provider Demographics
NPI:1376525667
Name:COTIAUX, GERTRUDE PO (MD)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:PO
Last Name:COTIAUX
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 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6306
Mailing Address - Fax:864-797-6306
Practice Address - Street 1:2400 BOILING SPRINGS RD STE A
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5304
Practice Address - Country:US
Practice Address - Phone:864-599-0731
Practice Address - Fax:864-599-0791
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7352-C207Q00000X
SC39086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2182043Medicaid
OH2182043Medicaid
OHH10979Medicare UPIN