Provider Demographics
NPI:1326016320
Name:KWATRA, KAPIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KAPIL
Middle Name:
Last Name:KWATRA
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 1:9371, EAST MARKET STREET, SUITE #1A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-609-5277
Mailing Address - Fax:330-609-5294
Practice Address - Street 1:9371, EAST MARKET STREET, SUITE #1A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-609-5277
Practice Address - Fax:330-609-5294
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35068993OtherLICENCE NUMBER
OH0186196Medicaid