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General NPI Number Information
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NPI Number | 1265663165
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Entity Type | Organization
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Legal Business Name | SHRIDHAR KOTTA MD PA
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 512 VICTORIA LN STE 4
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City | HARLINGEN
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State | TX
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Zip | 78550-3227
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Country | US
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Telephone | 956-341-6440
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 532409
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City | HARLINGEN
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State | TX
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Zip | 78553-2409
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Country | US
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Telephone | 956-341-6440
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHRIDHAR KOTTA
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Credential | MD
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Telephone | 956-341-6440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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