Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD057310L | PA |
NPI | 1003801507 |
---|---|
Provider Name | Dr. John T Cotter JR. |
First Address | Lancaster, PA 17601-4670 |
Second Address | Lancaster, PA 17601-4670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 18/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10925085 | (05) | PA |
G23979 | (02) |