Healthcare Provider Details

I. General information

NPI: 1922235688
Provider Name (Legal Business Name): KEVIN GERARD KOTAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OXFORD DR STE 560
BETHEL PARK PA
15102-1892
US

IV. Provider business mailing address

701 TECHNOLOGY DR STE 150
CANONSBURG PA
15317-9531
US

V. Phone/Fax

Practice location:
  • Phone: 412-831-1522
  • Fax: 412-835-2746
Mailing address:
  • Phone: 412-531-2902
  • Fax: 412-531-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS016064
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS016064
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS016064
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: