Provider Demographics
NPI:1629175922
Name:KOTA, MANJUSHA (MD)
Entity Type:Individual
Prefix:MS
First Name:MANJUSHA
Middle Name:
Last Name:KOTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MANJUSHA
Other - Middle Name:
Other - Last Name:KOTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1661 AIRPORT RD STE D
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8184
Mailing Address - Country:US
Mailing Address - Phone:501-625-7500
Mailing Address - Fax:501-625-7777
Practice Address - Street 1:180 MEDICAL PARK PL STE 201
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-463-5700
Practice Address - Fax:501-463-5710
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3542207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology