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NPI Code Detail

MEDICARE: DR. JAYARATHNE KOTTAGE MD

MEDICARE: DR. JAYARATHNE KOTTAGE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician2004021469MO
2174400000XSpecialist0101254569VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043236284
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAYARATHNE KOTTAGE MD
Provider Business Mailing Address
First Line : 1515 IDLEWILD BLVD
Second Line :
City : FREDERICKSBRG
State : VA
Zip : 22401-6623
Country : US
Telephone Number : 240-778-3761
Fax Number : 540-368-7599
Provider Business Practice Location Address
First Line : 300 PARK HILL DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-3387
Country : US
Telephone Number : 540-368-7405
Fax Number : 540-368-7599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 01/04/2024

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