MEDICARE: DR. RAKSHA A KOTHARI 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	MA041488	NJ
2	208M00000X	Hospitalist Physician	25MA04148800	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110170805	OTHER	NJ	RAILROAD MEDICARE

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	:	1992785083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAKSHA A KOTHARI M.D.

Provider Business Mailing Address
First Line	:	2201 CHAPEL AVE W
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-2048
Country	:	US
Telephone Number	:	856-566-6845
Fax Number	:	856-566-6906

Provider Business Practice Location Address
First Line	:	2201 CHAPEL AVE W
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-2048
Country	:	US
Telephone Number	:	856-566-6845
Fax Number	:	856-566-6906

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	11/01/2013

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