Provider Demographics
NPI:1841409075
Name:POTHIRAJ, KASTHURI (MD)
Entity Type:Individual
Prefix:MRS
First Name:KASTHURI
Middle Name:
Last Name:POTHIRAJ
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 1:6 GOLDENPOND DR
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-2181
Mailing Address - Country:US
Mailing Address - Phone:732-297-1960
Mailing Address - Fax:732-297-1960
Practice Address - Street 1:6 GOLDENPOND DR
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-2181
Practice Address - Country:US
Practice Address - Phone:732-297-1960
Practice Address - Fax:732-297-1960
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2112906Medicaid
C55816Medicare UPIN
NJ2112906Medicaid