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General NPI Number Information
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NPI Number | 1699775395
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Entity Type | Individual
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Provider Name | SOPHIA KOTLIAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 106 BOW ST DEPARTMENT OF PATHOLOGY
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City | ELKTON
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State | MD
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Zip | 21921-5544
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Country | US
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Telephone | 443-674-1289
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Fax |
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Provider Business Mailing Address
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Address Line | 640 S STATE ST
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City | DOVER
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State | DE
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Zip | 19901-3530
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Country | US
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Telephone | 302-744-7050
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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 | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | C10004615
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License Number State | DE
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