MEDICARE: DR. USHA S KOTIHAL 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
1	2084P0800X	Psychiatry Physician	MD063702L	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	:	1750457644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. USHA S KOTIHAL MD

Provider Business Mailing Address
First Line	:	331 MARIELLE DR
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-4415
Country	:	US
Telephone Number	:	215-856-4286
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N BROAD ST
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-2414
Country	:	US
Telephone Number	:	215-856-4286
Fax Number	:

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/13/2016

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