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General NPI Number Information
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NPI Number | 1972769396
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Entity Type | Individual
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Provider Name | SUMANKRISHNA KOTLA MD
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Gender | Male
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 411 N WASHINGTON AVE STE 7000
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City | DALLAS
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State | TX
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Zip | 75246-1791
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Country | US
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Telephone | 143-582-3002
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Fax | 214-579-6941
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Provider Business Mailing Address
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Address Line | 1086 FRANKLIN ST
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4305
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Country | US
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Telephone | 814-410-8300
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Fax | 814-410-8331
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R1400
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | R1400
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD443139
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License Number State | PA
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