MEDICARE: EVAN MICHAEL COTTRILL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	MA063024	PA

General Provider Information

NPI Number	:	1699439893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN MICHAEL COTTRILL PA-C

Provider Business Mailing Address
First Line	:	1909 SHADY OAK DR
Second Line	:
City	:	ALLISON PARK
State	:	PA
Zip	:	15101-1920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1908 WYLIE AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15219-4350
Country	:	US
Telephone Number	:	412-578-2388
Fax Number	:	412-471-1910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	07/28/2025

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