Provider Demographics
NPI:1659708873
Name:KOTULA, CARLI ANN (PA)
Entity Type:Individual
Prefix:
First Name:CARLI
Middle Name:ANN
Last Name:KOTULA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARLI
Other - Middle Name:ANN
Other - Last Name:BEACHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7870
Mailing Address - Fax:585-723-7871
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7870
Practice Address - Fax:585-723-7871
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169982086X0206X
NY016998363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology