Provider Demographics
NPI:1922093459
Name:COTELL, STEPHANIE L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:COTELL
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 1:925 N HAMILTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8709
Mailing Address - Country:US
Mailing Address - Phone:614-473-9519
Mailing Address - Fax:614-473-9543
Practice Address - Street 1:925 N HAMILTON RD STE 100
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8709
Practice Address - Country:US
Practice Address - Phone:614-473-9519
Practice Address - Fax:614-473-9543
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079994C207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCO4059851Medicare ID - Type Unspecified
OHG53572Medicare UPIN