Healthcare Provider Details

I. General information

NPI: 1275694408
Provider Name (Legal Business Name): VALERIE COTHRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S PACA ST
BALTIMORE MD
21201-1771
US

IV. Provider business mailing address

417 HILLSBORO DR
SILVER SPRING MD
20902-3160
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6792
  • Fax:
Mailing address:
  • Phone: 301-526-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberTP786
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberD64869
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: