Healthcare Provider Details

I. General information

NPI: 1811254626
Provider Name (Legal Business Name): JILL COTTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR DEPT OF FAMILY MEDICINE
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

9000 FRANKLIN SQUARE DR DEPT OF FAMILY MEDICINE
BALTIMORE MD
21237-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-2000
  • Fax: 443-777-2034
Mailing address:
  • Phone: 443-777-2000
  • Fax: 443-777-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0087958
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ9324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: