Provider Demographics
NPI:1639274079
Name:COTTAGE ORTHOPEDICS PLLC
Entity Type:Organization
Organization Name:COTTAGE ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAUCHLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-536-1565
Mailing Address - Street 1:15 TOWN WEST RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264
Mailing Address - Country:US
Mailing Address - Phone:603-536-1565
Mailing Address - Fax:603-536-1200
Practice Address - Street 1:15 TOWN WEST RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264
Practice Address - Country:US
Practice Address - Phone:603-536-1565
Practice Address - Fax:603-536-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8934207X00000X
VT0320000417207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4483620001OtherDEMERC
VT0019104Medicaid
NHRE2681Medicare ID - Type Unspecified
F61545Medicare UPIN