Healthcare Provider Details

I. General information

NPI: 1861446411
Provider Name (Legal Business Name): NIMMI R KOTHARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 FOULK RD SUITE #E
WILMINGTON DE
19810-3700
US

IV. Provider business mailing address

1805 FOULK RD SUITE #E
WILMINGTON DE
19810-3700
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-0500
  • Fax: 302-475-4608
Mailing address:
  • Phone: 302-475-0500
  • Fax: 302-475-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0001894
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: