Provider Demographics
NPI:1033735949
Name:KOTHADIA, RADHIKA JAMANADAS (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:JAMANADAS
Last Name:KOTHADIA
Suffix:
Gender:F
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:GENERAL PSYCHIATRY
Mailing Address - Street 2:15 MEDICAL PAR, STE 141
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-1433
Mailing Address - Fax:803-434-4062
Practice Address - Street 1:GENERAL PSYCHIATRY
Practice Address - Street 2:15 MEDICAL PAR, STE 141
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-1433
Practice Address - Fax:803-434-4062
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL844422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry