Provider Demographics
NPI:1598728552
Name:KOTHARI, NITA H (MD)
Entity Type:Individual
Prefix:DR
First Name:NITA
Middle Name:H
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:1 S CENTRE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2213
Practice Address - Country:US
Practice Address - Phone:856-655-7337
Practice Address - Fax:856-655-3938
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA0369000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN