Provider Demographics
NPI:1659439644
Name:KOTHARI, KINNARI A (MD)
Entity Type:Individual
Prefix:DR
First Name:KINNARI
Middle Name:A
Last Name:KOTHARI
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 1:1 BRITTON PL
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2514
Mailing Address - Country:US
Mailing Address - Phone:856-772-0700
Mailing Address - Fax:856-864-0310
Practice Address - Street 1:1 BRITTON PL
Practice Address - Street 2:SUITE # 6
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2514
Practice Address - Country:US
Practice Address - Phone:856-772-0700
Practice Address - Fax:856-864-0310
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA054424002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050886OtherVALUE OPTIONS
NJ202304OtherMANAGED HEALTH NETWORK
NJ7534730OtherAETNA
NJP3645687OtherOXFORD
NJ0445029000OtherINDEPENDENCE BLUE CROSS
NJ0445029000OtherAMERIHEALTH
NJ616694Medicare ID - Type Unspecified
NJ202304OtherMANAGED HEALTH NETWORK