Healthcare Provider Details

I. General information

NPI: 1124094073
Provider Name (Legal Business Name): RUPAL KOTHARI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CENTRAL AVE 2ND FLOOR
MALVERN PA
19355-3265
US

IV. Provider business mailing address

PO BOX 350
SELLERSVILLE PA
18960-0350
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6755
  • Fax: 610-647-2063
Mailing address:
  • Phone: 215-723-2333
  • Fax: 215-723-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS009881-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: