Healthcare Provider Details

I. General information

NPI: 1427013226
Provider Name (Legal Business Name): JAMNADAS M KOTHADIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY M KOTHADIA MD

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

IV. Provider business mailing address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-4015
  • Fax: 704-384-5612
Mailing address:
  • Phone: 704-384-4015
  • Fax: 704-384-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number34654
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: