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General NPI Number Information
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NPI Number | 1639427396
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Entity Type | Organization
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Legal Business Name | AJOY KOTWAL MD PA
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 3102 W CYPRESS ST SUITE B
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City | TAMPA
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State | FL
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Zip | 33607-5118
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Country | US
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Telephone | 813-874-1404
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Fax | 813-874-9305
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Provider Business Mailing Address
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Address Line | 3102 W CYPRESS ST SUITE B
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City | TAMPA
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State | FL
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Zip | 33607-5118
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Country | US
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Telephone | 813-874-1404
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Fax | 813-874-9305
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Authorized Official
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Title or Position | OWNER
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Name | DR. AJOY KOTWAL
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Credential | MD
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Telephone | 813-874-1404
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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 | ME0065983
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License Number State | FL
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