Healthcare Provider Details

I. General information

NPI: 1699739532
Provider Name (Legal Business Name): KAMAL KOTHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 CLINTON AVE S
ROCHESTER NY
14618-2623
US

IV. Provider business mailing address

2263 CLINTON AVE S
ROCHESTER NY
14618-2623
US

V. Phone/Fax

Practice location:
  • Phone: 585-241-6400
  • Fax: 585-241-6872
Mailing address:
  • Phone: 585-241-6400
  • Fax: 585-641-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number141316
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: