Provider Demographics
NPI:1275598518
Name:KOTHARI, SAROJ (MD)
Entity Type:Individual
Prefix:DR
First Name:SAROJ
Middle Name:
Last Name:KOTHARI
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 1:4051 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3770
Mailing Address - Country:US
Mailing Address - Phone:330-477-7800
Mailing Address - Fax:330-477-5613
Practice Address - Street 1:4051 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3770
Practice Address - Country:US
Practice Address - Phone:330-477-7800
Practice Address - Fax:330-477-5613
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0522438Medicaid
OHKO0532973Medicare ID - Type Unspecified
OH0522438Medicaid