Provider Demographics
NPI:1336329465
Name:KURTAKOTI, SOWMYA S (MD)
Entity Type:Individual
Prefix:
First Name:SOWMYA
Middle Name:S
Last Name:KURTAKOTI
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 1:1229 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-2132
Mailing Address - Country:US
Mailing Address - Phone:860-524-9820
Mailing Address - Fax:860-524-9821
Practice Address - Street 1:1229 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-2132
Practice Address - Country:US
Practice Address - Phone:860-524-9820
Practice Address - Fax:860-524-9821
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048300207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine