Healthcare Provider Details

I. General information

NPI: 1811206352
Provider Name (Legal Business Name): JAMES THORTON HAYDOCK COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 W FAYETTE ST
BALTIMORE MD
21223-1938
US

IV. Provider business mailing address

351 BROADVIEW LN
ANNAPOLIS MD
21401-7238
US

V. Phone/Fax

Practice location:
  • Phone: 410-987-3342
  • Fax:
Mailing address:
  • Phone: 443-797-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA00645
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: