Healthcare Provider Details

I. General information

NPI: 1275598518
Provider Name (Legal Business Name): SAROJ KOTHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 LINCOLN WAY E
MASSILLON OH
44646-3770
US

IV. Provider business mailing address

4051 LINCOLN WAY E
MASSILLON OH
44646-3770
US

V. Phone/Fax

Practice location:
  • Phone: 330-477-7800
  • Fax: 330-477-5613
Mailing address:
  • Phone: 330-477-7800
  • Fax: 330-477-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35043958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: