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General NPI Number Information
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NPI Number | 1093133795
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Entity Type | Individual
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Provider Name | SHANNON RUTH KOTCH MD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 11/04/2023
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Provider Practice Location Address
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Address Line | 620 HOWARD AVE
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City | ALTOONA
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State | PA
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Zip | 16601-4804
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Country | US
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Telephone | 570-332-2945
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Fax |
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Provider Business Mailing Address
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Address Line | 549 OVERLOOK DR
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-3909
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Country | US
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Telephone | 570-332-2945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MD482830
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | MD482830
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License Number State | PA
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