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General NPI Number Information
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NPI Number | 1851658561
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Entity Type | Individual
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Provider Name | TARA COTTON PA
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Gender | Female
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 20 YORK ST SPC 2213 MDRAD DIAGNOSTIC RADIOLOGY
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-370-7726
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 208042 MDRAD DIAGNOSTIC RADIOLOGY
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City | NEW HAVEN
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State | CT
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Zip | 06520-8042
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Country | US
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Telephone | 203-370-7726
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 23.002740
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License Number State | CT
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