Provider Demographics
NPI:1649477555
Name:COTTER, THUSITHA (MD)
Entity type:Individual
Prefix:
First Name:THUSITHA
Middle Name:
Last Name:COTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALLEN STREET
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-747-3639
Mailing Address - Fax:802-747-6207
Practice Address - Street 1:147 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4555
Practice Address - Country:US
Practice Address - Phone:802-775-1901
Practice Address - Fax:802-775-1974
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49955207V00000X
ME018019207V00000X
VT042-0013490207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN267120000Medicaid
MNP00413269OtherRAILROAD MEDICARE
ME000968901Medicare PIN
MNP00413269OtherRAILROAD MEDICARE