Provider Demographics
NPI:1710942982
Name:KOTHARI, RAJNIKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJNIKANT
Middle Name:
Last Name:KOTHARI
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 1:4051 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3770
Mailing Address - Country:US
Mailing Address - Phone:330-477-8770
Mailing Address - Fax:330-477-5613
Practice Address - Street 1:4051 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3770
Practice Address - Country:US
Practice Address - Phone:330-477-8770
Practice Address - Fax:330-477-5613
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350434102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0405485Medicaid
OH0405485Medicaid
OHC01721Medicare UPIN