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General NPI Number Information
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NPI Number | 1255577581
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Entity Type | Individual
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Provider Name | CARLA J KOTSIFAKIS P.A.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 05/30/2017
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Provider Practice Location Address
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Address Line | 10304 TIMBERLAKE CT
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City | OCEAN CITY
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State | MD
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Zip | 21842-8837
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Country | US
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Telephone | 410-251-8224
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Fax | 410-213-7195
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Provider Business Mailing Address
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Address Line | 10304 TIMBERLAKE CT
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City | OCEAN CITY
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State | MD
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Zip | 21842-8837
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Country | US
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Telephone | 410-251-8224
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Fax | 410-213-7195
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0000548
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0001667
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License Number State | MD
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