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General NPI Number Information
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NPI Number | 1811206352
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Entity Type | Individual
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Provider Name | JAMES THORTON HAYDOCK COTA
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Gender | Male
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 1217 W FAYETTE ST
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City | BALTIMORE
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State | MD
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Zip | 21223-1938
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Country | US
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Telephone | 410-987-3342
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Fax |
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Provider Business Mailing Address
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Address Line | 351 BROADVIEW LN
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7238
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Country | US
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Telephone | 443-797-3933
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Fax |
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | A00645
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License Number State | MD
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