Provider Demographics
NPI:1548328271
Name:COTTER, JOHN P (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:COTTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1588 GEER HWY
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-9204
Mailing Address - Country:US
Mailing Address - Phone:864-836-1109
Mailing Address - Fax:864-836-6365
Practice Address - Street 1:1588 GEER HWY
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-9204
Practice Address - Country:US
Practice Address - Phone:864-836-1109
Practice Address - Fax:864-836-6365
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC17270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF48797Medicare UPIN