Provider Demographics
NPI:1659629780
Name:NEVILLE H. KOTWAL, MD, LLC
Entity Type:Organization
Organization Name:NEVILLE H. KOTWAL, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOTWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-882-1355
Mailing Address - Street 1:601 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6332
Mailing Address - Country:US
Mailing Address - Phone:610-882-1355
Mailing Address - Fax:610-882-3181
Practice Address - Street 1:601 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6332
Practice Address - Country:US
Practice Address - Phone:610-882-1355
Practice Address - Fax:610-882-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044889L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001271910-0011Medicaid
PA001271910-0011Medicaid
PA704857Medicare PIN