Healthcare Provider Details

I. General information

NPI: 1073945143
Provider Name (Legal Business Name): NIHAR HOTCHANDANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST. 6 FOUNDERS
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

4210 SANSOM ST APT 408
PHILADELPHIA PA
19104-3589
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3209
  • Fax:
Mailing address:
  • Phone: 267-584-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD460601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number61858
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMT205132
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: