Provider Demographics
NPI:1295769545
Name:COTTAGE ORTHOPEDICS PLLC
Entity type:Organization
Organization Name:COTTAGE ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GENNARO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:603-747-3668
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216-0032
Mailing Address - Country:US
Mailing Address - Phone:603-735-6060
Mailing Address - Fax:603-735-6070
Practice Address - Street 1:15 TOWN WEST RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3428
Practice Address - Country:US
Practice Address - Phone:603-536-1565
Practice Address - Fax:603-536-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8934207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008820Medicaid
NH200002520OtherMVP
NH4483620001OtherDMERC
NH30232107Medicaid
NHCJ7687OtherRAILROAD MEDICARE
NH175805800OtherUS DEPARTMENT OF LABOR
MAZCA707OtherANTHEM
VT1008820Medicaid
NH30232107Medicaid
NHCJ7687OtherRAILROAD MEDICARE