Healthcare Provider Details

I. General information

NPI: 1235592197
Provider Name (Legal Business Name): GRAEME DAVIS COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23816 BIRCH LN
LEWES DE
19958-5341
US

IV. Provider business mailing address

PO BOX 1288
REHOBOTH BEACH DE
19971-1288
US

V. Phone/Fax

Practice location:
  • Phone: 302-490-7858
  • Fax:
Mailing address:
  • Phone: 302-490-7858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License NumberU2-1125
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number46TA09023600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: