Basic Information
| Provider Information | |||||||||
| NPI: | 1639274079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COTTAGE ORTHOPEDICS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 TOWN WEST RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035361565 | ||||||||
| FaxNumber: | 6035361200 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 TOWN WEST RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035361565 | ||||||||
| FaxNumber: | 6035361200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAUCHLY | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6035361565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0320000417 | VT | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 8934 | NH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4483620001 | 01 | DEMERC | OTHER | 0019104 | 05 | VT | MEDICAID |