Provider Demographics
NPI:1689687287
Name:KOTTOOR, VINAYAK (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAYAK
Middle Name:
Last Name:KOTTOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 REDDICK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-2717
Mailing Address - Country:US
Mailing Address - Phone:828-651-0121
Mailing Address - Fax:828-651-0141
Practice Address - Street 1:600 JULIAN LN
Practice Address - Street 2:STE 630
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7812
Practice Address - Country:US
Practice Address - Phone:828-651-0121
Practice Address - Fax:828-651-0141
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070905207R00000X, 207SG0201X, 208000000X
NC2013-02156207SG0201X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420200700Medicaid
MD191647Y82Medicare PIN