Provider Demographics
NPI:1265663165
Name:SHRIDHAR KOTTA MD PA
Entity Type:Organization
Organization Name:SHRIDHAR KOTTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-341-6440
Mailing Address - Street 1:PO BOX 532409
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2409
Mailing Address - Country:US
Mailing Address - Phone:956-341-6440
Mailing Address - Fax:
Practice Address - Street 1:512 VICTORIA LN STE 4
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3227
Practice Address - Country:US
Practice Address - Phone:956-341-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty