Healthcare Provider Details

I. General information

NPI: 1770802266
Provider Name (Legal Business Name): ASHOT S KOTCHARIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BAHIA VISTA ST STE 100
SARASOTA FL
34239-2640
US

IV. Provider business mailing address

2750 BAHIA VISTA ST STE 100
SARASOTA FL
34239-2640
US

V. Phone/Fax

Practice location:
  • Phone: 941-951-2663
  • Fax: 941-552-3312
Mailing address:
  • Phone: 941-951-2663
  • Fax: 941-552-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD451781
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: