Basic Information
| Provider Information | |||||||||
| NPI: | 1609804137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COTTER | ||||||||
| FirstName: | SUZANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 MACK BLVD FL 4 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181035622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705016368 | ||||||||
| FaxNumber: | 5705014754 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 S CLAUDE A BLVD | ||||||||
| Address2: | |||||||||
| City: | POTTSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179013639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707282424 | ||||||||
| FaxNumber: | 5707282425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D0054995 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD469554 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 022004300 | 05 | MD | MEDICAID | 103982530-0001 | 05 | PA | MEDICAID | 536403500 | 05 | MD | MEDICAID |