Healthcare Provider Details

I. General information

NPI: 1093041295
Provider Name (Legal Business Name): DANA K COTHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA PURCELL

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BESTGATE RD STE 400
ANNAPOLIS MD
21401-3371
US

IV. Provider business mailing address

1000 BESTGATE RD STE 400
ANNAPOLIS MD
21401-3371
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-2720
  • Fax: 410-224-0209
Mailing address:
  • Phone: 410-266-2720
  • Fax: 410-224-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1370
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0006207
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: