Provider Demographics
NPI:1891804852
Name:PAUL B COTTER MD PC
Entity Type:Organization
Organization Name:PAUL B COTTER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-586-0256
Mailing Address - Street 1:179 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302
Mailing Address - Country:US
Mailing Address - Phone:508-586-0256
Mailing Address - Fax:508-586-4544
Practice Address - Street 1:179 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302
Practice Address - Country:US
Practice Address - Phone:508-586-0256
Practice Address - Fax:508-586-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43625207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD35120000OtherDAVIS VISION
MAM13897OtherBLUE CROSS AND BLUE SHIEL
MA9736816Medicaid
MA9736816Medicaid
MA=========OtherCIGNA
MA9736816Medicaid
M13897Medicare ID - Type Unspecified