Provider Demographics
NPI:1477560811
Name:COTTON, PAUL GERALD (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GERALD
Last Name:COTTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 S WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3901
Mailing Address - Country:US
Mailing Address - Phone:802-860-0163
Mailing Address - Fax:802-860-0164
Practice Address - Street 1:186 S WILLARD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3901
Practice Address - Country:US
Practice Address - Phone:802-860-0163
Practice Address - Fax:802-860-0164
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA333562084F0202X, 2084P0800X, 2084P0802X
VT042-00090262084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1042Medicaid
VTB72772Medicare UPIN
VTOVN1042Medicaid