Provider Demographics
NPI:1558334201
Name:COTTLE, RONALD WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WADE
Last Name:COTTLE
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:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-0790
Mailing Address - Country:US
Mailing Address - Phone:910-641-0400
Mailing Address - Fax:910-642-5929
Practice Address - Street 1:103 S OWEN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-8878
Practice Address - Country:US
Practice Address - Phone:910-862-2900
Practice Address - Fax:910-862-2900
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7924670Medicaid
NC24670OtherBCBS OF NC
C82067Medicare UPIN
203775DMedicare ID - Type Unspecified