MEDICARE: MARK KOTLAREWSKY

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
1	207R00000X	Internal Medicine Physician	MD036355	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154485621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK KOTLAREWSKY

Provider Business Mailing Address
First Line	:	110 IRVING ST NW
Second Line	:	STE 2A-38E
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2975
Country	:	US
Telephone Number	:	202-877-4677
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 IRVING ST NW
Second Line	:	STE 2A-38E
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2975
Country	:	US
Telephone Number	:	202-877-4677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/21/2011

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