Healthcare Provider Details

I. General information

NPI: 1235580671
Provider Name (Legal Business Name): DR. FAINA KOTOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-6110
US

IV. Provider business mailing address

75 FRANCIS ST DEPT OF
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number282630
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number282630
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: