Provider Demographics
NPI:1588827232
Name:KOTOVA, SVETLANA (MD)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:KOTOVA
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:200 NE MOTHER JOSEPH PL STE 320
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3205
Practice Address - Country:US
Practice Address - Phone:360-514-6300
Practice Address - Fax:360-514-6301
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD170113208G00000X
WAMD61188216208G00000X
NY246460208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery