Provider Demographics
NPI:1770837189
Name:KATHROTIYA, PUJA RAMJI (MD)
Entity Type:Individual
Prefix:DR
First Name:PUJA
Middle Name:RAMJI
Last Name:KATHROTIYA
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:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:4351 CORTEZ RD W STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3140
Practice Address - Country:US
Practice Address - Phone:941-755-0066
Practice Address - Fax:941-487-6227
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN19154207N00000X
FLME124603207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIT698YMedicare PIN
FLIT698ZMedicare PIN