Provider Demographics
NPI:1699745521
Name:COTTER, PAUL BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BARRY
Last Name:COTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22 CHRISTY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1839
Mailing Address - Country:US
Mailing Address - Phone:508-588-3060
Mailing Address - Fax:508-587-5774
Practice Address - Street 1:22 CHRISTY DR STE 1
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-588-3060
Practice Address - Fax:508-587-5774
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAMA43625207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0137049Medicaid
MAJ03215Medicare ID - Type Unspecified
MA0137049Medicaid