Healthcare Provider Details

I. General information

NPI: 1447687835
Provider Name (Legal Business Name): SANDRA DIANE REIGER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 49TH ST NE
WASHINGTON DC
20019-4706
US

IV. Provider business mailing address

276 SIGMA DR
HARWOOD MD
20776-9761
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-6870
  • Fax:
Mailing address:
  • Phone: 443-995-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOTA00000253
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: