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NPI Code Detail

MEDICARE: DR. KRISTA BOTT M.D.

MEDICARE: DR. KRISTA BOTT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianMT194819PA
2208600000XSurgery PhysicianMD451073PA

General Provider Information

NPI Number : 1104051200
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTA BOTT M.D.
Provider Business Mailing Address
First Line : 206 E BROWN ST
Second Line : POCONO HEALTH SYSTEM - PROFESSIONAL CENTER
City : EAST STROUDSBURG
State : PA
Zip : 18301-3006
Country : US
Telephone Number : 570-420-4919
Fax Number : 570-426-2643
Provider Business Practice Location Address
First Line : 600 COMMERCE BLVD
Second Line : 3RD FLOOR
City : STROUDSBURG
State : PA
Zip : 18360-6214
Country : US
Telephone Number : 570-426-6070
Fax Number : 570-422-8091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2009
Last Update Date : 05/04/2023

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Directions to “ DR. KRISTA BOTT M.D.” Practice Location

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