Healthcare Provider Details

I. General information

NPI: 1720262546
Provider Name (Legal Business Name): OSTERMAN COTES, M.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 POPLAR ST SUITE 200
SOUTH CHARLESTON WV
25309-1474
US

IV. Provider business mailing address

500 POPLAR ST SUITE 200
SOUTH CHARLESTON WV
25309-1474
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-3400
  • Fax: 304-766-3499
Mailing address:
  • Phone: 304-766-3400
  • Fax: 304-766-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberD9983
License Number StateWV

VIII. Authorized Official

Name: OSTERMAN COTES
Title or Position: OWNER
Credential: MD
Phone: 304-766-3400