Healthcare Provider Details

I. General information

NPI: 1033735949
Provider Name (Legal Business Name): RADHIKA JAMANADAS KOTHADIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GENERAL PSYCHIATRY 15 MEDICAL PAR, STE 141
COLUMBIA SC
29203
US

IV. Provider business mailing address

GENERAL PSYCHIATRY 15 MEDICAL PAR, STE 141
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-1433
  • Fax: 803-434-4062
Mailing address:
  • Phone: 803-434-1433
  • Fax: 803-434-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number32172001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: