Healthcare Provider Details

I. General information

NPI: 1245331321
Provider Name (Legal Business Name): JOHN GAVIN COTTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 ALLEN ST STE 8
RUTLAND VT
05701-4564
US

IV. Provider business mailing address

342 STONE HOLW
MENDON VT
05701-6770
US

V. Phone/Fax

Practice location:
  • Phone: 802-772-7169
  • Fax: 802-772-7215
Mailing address:
  • Phone: 802-772-7169
  • Fax: 802-772-7353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49954
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number49954
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01089181A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number017996
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036129082
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number12195
License Number StateNH
# 7
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number042.0013442
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: