Provider Demographics
NPI:1487110847
Name:LOTT, COREY JAMAL
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:JAMAL
Last Name:LOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 CAVALIER BLVD
Mailing Address - Street 2:
Mailing Address - City:PONTAMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701
Mailing Address - Country:US
Mailing Address - Phone:757-297-9086
Mailing Address - Fax:
Practice Address - Street 1:1604 CAVALIER BLVD
Practice Address - Street 2:
Practice Address - City:PONTAMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701
Practice Address - Country:US
Practice Address - Phone:757-297-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No335G00000XSuppliersMedical Foods Supplier
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No347E00000XTransportation ServicesTransportation Broker
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No175T00000XOther Service ProvidersPeer Specialist
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies