Healthcare Provider Details

I. General information

NPI: 1770696189
Provider Name (Legal Business Name): MAXWELL TRYGVE COTTER MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 N ORCHARD DR
BURBANK CA
91504-2210
US

IV. Provider business mailing address

2511 N ORCHARD DR
BURBANK CA
91504-2210
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-2415
  • Fax: 818-566-4345
Mailing address:
  • Phone: 818-843-2415
  • Fax: 818-566-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA2094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: