Healthcare Provider Details

I. General information

NPI: 1306936745
Provider Name (Legal Business Name): PRITI M KOTHARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 CENTRAL PARK BLVD N STE. 235
BOCA RATON FL
33428-1759
US

IV. Provider business mailing address

9960 CENTRAL PARK BLVD N STE. 235
BOCA RATON FL
33428-1759
US

V. Phone/Fax

Practice location:
  • Phone: 561-483-0844
  • Fax: 561-483-3342
Mailing address:
  • Phone: 561-483-0844
  • Fax: 561-483-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME93043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: