Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | MD017816E | PA |
Y | 207KA0200X | Allergist | MD017816E | PA |
N | 208000000X | Pediatrician | MD017816E | PA |
N | 2080P0201X | Pediatric Allergist | MD017816E | PA |
NPI | 1942305081 |
---|---|
Provider Name | Dr. Marc D Cotler |
First Address | Ardmore, PA 19003-2321 |
Second Address | Ardmore, PA 19003-2321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 19/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B36951 | (02) | PA |