Healthcare Provider Details

I. General information

NPI: 1497195390
Provider Name (Legal Business Name): RAVISH ASHOKKUMAR KOTHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MED PARK STE 420 NEUROLOGY
COLUMBIA SC
29203
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-545-6072
  • Fax: 803-545-6051
Mailing address:
  • Phone: 803-434-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35909
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: