MEDICARE: JOHN COTHERN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0102205819	VA

General Provider Information

NPI Number	:	1295237006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN COTHERN DO

Provider Business Mailing Address
First Line	:	6816 BELMONT DR
Second Line	:
City	:	SHAWNEE
State	:	KS
Zip	:	66226-5301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 MAURY AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-1822
Country	:	US
Telephone Number	:	913-231-5588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	09/11/2024

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