Healthcare Provider Details

I. General information

NPI: 1023309291
Provider Name (Legal Business Name): PRACHI DILIP KOTHARI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 09/30/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S GODDARD BLVD FL 2
KING OF PRUSSIA PA
19406-2922
US

IV. Provider business mailing address

339 N BROAD ST APT 2404
PHILADELPHIA PA
19107-1021
US

V. Phone/Fax

Practice location:
  • Phone: 267-425-3320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number278862-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS022016
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberOS022016
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: