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General NPI Number Information
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NPI Number | 1134288376
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Entity Type | Individual
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Provider Name | MARK SAMUEL COTTERELL MD
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | SILVER STREET CONNECTICUT VALLEY HOSPITAL
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-262-5867
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Fax | 860-262-5850
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Provider Business Mailing Address
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Address Line | PO BOX 351 SILVER STREET CONNECTICUT VALLEY HOSPITAL
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City | MIDDLETOWN
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State | CT
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Zip | 06457
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Country | US
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Telephone | 860-262-5867
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Fax | 860-262-5850
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101042896
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 038977
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License Number State | CT
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