Healthcare Provider Details

I. General information

NPI: 1649477555
Provider Name (Legal Business Name): THUSITHA COTTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 ALLEN ST
RUTLAND VT
05701-4555
US

IV. Provider business mailing address

160 ALLEN STREET MEDICAL STAFF SERVICES
RUTLAND VT
05701
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-1901
  • Fax: 802-775-1974
Mailing address:
  • Phone: 802-747-3639
  • Fax: 802-747-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number49955
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number018019
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number042-0013490
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: