Provider Demographics
NPI:1760437107
Name:COTTINGHAM, TERI J (MD)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:J
Last Name:COTTINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N CURTIS RD
Mailing Address - Street 2:STE 505
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1336
Mailing Address - Country:US
Mailing Address - Phone:208-327-9521
Mailing Address - Fax:208-327-9524
Practice Address - Street 1:999 N CURTIS RD
Practice Address - Street 2:STE 505
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1336
Practice Address - Country:US
Practice Address - Phone:208-327-9521
Practice Address - Fax:208-327-9524
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7506207N00000X
IDM-7506207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805151100Medicaid
ID1368428Medicare PIN
IDG35022Medicare UPIN