Provider Demographics
NPI:1508974270
Name:COTTER, MARY-ELLEN LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY-ELLEN
Middle Name:LESLIE
Last Name:COTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARYELLEN
Other - Middle Name:LESLIE
Other - Last Name:COTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4526 FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2132
Mailing Address - Country:US
Mailing Address - Phone:425-349-6200
Mailing Address - Fax:
Practice Address - Street 1:4526 FEDERAL AVE
Practice Address - Street 2:BLDG. 9
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-349-6320
Practice Address - Fax:425-349-6325
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000344682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8246746Medicaid
WAAB37147Medicare ID - Type Unspecified
WA8246746Medicaid