Provider Demographics
NPI:1851520258
Name:COTHRAN, NICOLE ANN (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:701 GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5601
Mailing Address - Country:US
Mailing Address - Phone:864-455-7165
Mailing Address - Fax:864-455-3685
Practice Address - Street 1:701 GROVE ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5601
Practice Address - Country:US
Practice Address - Phone:864-455-7165
Practice Address - Fax:864-455-3685
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC381522080N0001X
PAMT2028502080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine