Provider Demographics
NPI:1992714794
Name:COTELINGAM, GRACE MONICA
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:MONICA
Last Name:COTELINGAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64277
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4277
Mailing Address - Country:US
Mailing Address - Phone:410-328-7037
Mailing Address - Fax:410-328-3311
Practice Address - Street 1:630 W FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1543
Practice Address - Country:US
Practice Address - Phone:410-328-2207
Practice Address - Fax:410-328-9233
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00647992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry