Healthcare Provider Details

I. General information

NPI: 1477162733
Provider Name (Legal Business Name): ADVAIT KODOOR KOTHARE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 CENTRE AVE
PITTSBURGH PA
15232-1304
US

IV. Provider business mailing address

600 GRANT ST
PITTSBURGH PA
15219-2702
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-2121
  • Fax:
Mailing address:
  • Phone: 412-432-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD485498
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: