Provider Demographics
NPI:1659074805
Name:COTTRILL, CAMERON LEE (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:LEE
Last Name:COTTRILL
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 1:1018 BOWLES RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:WV
Mailing Address - Zip Code:25124-7434
Mailing Address - Country:US
Mailing Address - Phone:304-807-4807
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3656
Practice Address - Country:US
Practice Address - Phone:182-430-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program