MEDICARE: SUREKHA VENKATA KOTAPOTHULA M.D.

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
1	207R00000X	Internal Medicine Physician	MD437413	PA
2	208M00000X	Hospitalist Physician	MD437413	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1184800781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUREKHA VENKATA KOTAPOTHULA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 300
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-0300
Country	:	US
Telephone Number	:	717-270-7780
Fax Number	:	717-274-9746

Provider Business Practice Location Address
First Line	:	4TH AND WALNUT STREETS
Second Line	:	3RD FLOOR
City	:	LEBANON
State	:	PA
Zip	:	17042-6123
Country	:	US
Telephone Number	:	717-270-4876
Fax Number	:	717-270-3875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	02/25/2020

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