Healthcare Provider Details

I. General information

NPI: 1902005705
Provider Name (Legal Business Name): PETER MAININI COTAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LITTLE TREE LN
BELLINGHAM MA
02019-2911
US

IV. Provider business mailing address

17 LITTLE TREE LN
BELLINGHAM MA
02019-2911
US

V. Phone/Fax

Practice location:
  • Phone: 508-479-8010
  • Fax:
Mailing address:
  • Phone: 508-479-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: