Provider Demographics
NPI:1003547035
Name:AL KOTOB, ABDULRAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:ABDULRAHMAN
Middle Name:
Last Name:AL KOTOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GENGRAS CLINIC AT ST. FRANCES HOSPITAL
Mailing Address - Street 2:1000 ASYLUM AVENUE, SUITE 1004
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-4632
Mailing Address - Fax:860-714-8275
Practice Address - Street 1:GENGRAS CLINIC AT ST. FRANCES HOSPITAL
Practice Address - Street 2:1000 ASYLUM AVENUE, SUITE 1004
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-4632
Practice Address - Fax:860-714-8275
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2023-05-18
Deactivation Date:2023-03-08
Deactivation Code:
Reactivation Date:2023-05-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program