Provider Demographics
NPI:1164512836
Name:KOTLABA, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:KOTLABA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 S MAIN ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2927
Mailing Address - Country:US
Mailing Address - Phone:434-791-3009
Mailing Address - Fax:434-791-3228
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2927
Practice Address - Country:US
Practice Address - Phone:434-791-3009
Practice Address - Fax:434-791-3228
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101221387207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA265400OtherANTHEM
VA5836026Medicaid
NC690586TOtherNC MEDICAID
NC690586TOtherNC MEDICAID
G95268Medicare UPIN