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General NPI Number Information
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NPI Number | 1225133408
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Entity Type | Organization
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Legal Business Name | COTTLE MEDICAL GROUP PA
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 103 S OWEN STREET
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337
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Country | US
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Telephone | 910-862-2900
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Fax | 910-862-2982
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Provider Business Mailing Address
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Address Line | PO BOX 790
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City | WHITEVILLE
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State | NC
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Zip | 28472-0790
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Country | US
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Telephone | 910-641-0400
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Fax | 910-642-5929
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD WADE COTTLE
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Credential | MD
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Telephone | 910-862-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30015
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License Number State | NC
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