Provider Demographics
NPI:1003110230
Name:KOTARSKY, DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:KOTARSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANDTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15458-0096
Mailing Address - Country:US
Mailing Address - Phone:412-582-6296
Mailing Address - Fax:855-737-2544
Practice Address - Street 1:25700 SCIENCE PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7328
Practice Address - Country:US
Practice Address - Phone:216-831-1040
Practice Address - Fax:216-831-2667
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6726OtherLICENSED PSYCHOLOGIST
OH3134021Medicaid
OHCP35441OtherMEDICARE PTAN