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General NPI Number Information
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NPI Number | 1164542957
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Entity Type | Organization
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Legal Business Name | KIRIT K KOTHARI MD PC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | ROUTE 115 & SWITZGABLE ROAD
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322
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Country | US
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Telephone | 570-992-1234
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Fax | 570-992-8610
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Provider Business Mailing Address
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Address Line | PO BOX 637
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322
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Country | US
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Telephone | 570-992-1234
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Fax | 570-992-8610
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Authorized Official
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Title or Position | MD PRESIDENT KIRIT K KOTHARI MD PC
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Name | DR. KIRIT K KOTHARI
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Credential | MD
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Telephone | 570-992-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | MD058095L
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License Number State | PA
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