Healthcare Provider Details

I. General information

NPI: 1952692584
Provider Name (Legal Business Name): KUNAL DIPAK KOTHARI M.D., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2011
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E JEFFERSON ST
ROCKVILLE MD
20852
US

IV. Provider business mailing address

2101 E JEFFERSON ST
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-816-6879
  • Fax: 855-414-2812
Mailing address:
  • Phone: 301-816-6879
  • Fax: 855-414-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0078571
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: