Provider Demographics
NPI:1346221033
Name:KOTHARI, PRASHANT S (MD)
Entity Type:Individual
Prefix:
First Name:PRASHANT
Middle Name:S
Last Name:KOTHARI
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 1:485 W MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883
Mailing Address - Country:US
Mailing Address - Phone:419-448-1900
Mailing Address - Fax:419-448-4553
Practice Address - Street 1:485 W MARKET STREET
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:419-448-1900
Practice Address - Fax:419-448-4553
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044361170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0422680Medicaid
OH0422680Medicaid