Healthcare Provider Details

I. General information

NPI: 1568852838
Provider Name (Legal Business Name): ARUN JOSE KOTTARATHARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 LIMESTONE RD
WILMINGTON DE
19808-5553
US

IV. Provider business mailing address

2006 LIMESTONE RD
WILMINGTON DE
19808-5553
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-2383
  • Fax:
Mailing address:
  • Phone: 302-355-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD61151370
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number1676-320
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4301113282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: