Healthcare Provider Details

I. General information

NPI: 1922089648
Provider Name (Legal Business Name): INGRID E KOTCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PERFORMANCE DR
WEYMOUTH MA
02189-3104
US

IV. Provider business mailing address

141 LONGWATER DR
NORWELL MA
02061-1632
US

V. Phone/Fax

Practice location:
  • Phone: 781-682-8000
  • Fax: 781-335-1412
Mailing address:
  • Phone: 781-878-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number207333
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: