Healthcare Provider Details

I. General information

NPI: 1891722856
Provider Name (Legal Business Name): ANDREAS KOTZUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

PO BOX 784305
PHILADELPHIA PA
19178-4305
US

V. Phone/Fax

Practice location:
  • Phone: 202-574-6851
  • Fax: 202-279-7370
Mailing address:
  • Phone: 844-565-6473
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101248705
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number70090
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0078086
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301106486
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD034204
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: