Healthcare Provider Details

I. General information

NPI: 1740397728
Provider Name (Legal Business Name): KOTHARI MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
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: 330-477-8770
  • Fax: 330-477-5613
Mailing address:
  • Phone: 330-477-8770
  • Fax: 330-477-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35043958
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35043410
License Number StateOH

VIII. Authorized Official

Name: DR. RAJNIKANT KOTHARI
Title or Position: PRESIDENT
Credential: MD
Phone: 330-477-8770