Provider Demographics
NPI:1861446411
Name:KOTHARI, NIMMI R (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMMI
Middle Name:R
Last Name:KOTHARI
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 1:1805 FOULK RD
Mailing Address - Street 2:SUITE #E
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3700
Mailing Address - Country:US
Mailing Address - Phone:302-475-0500
Mailing Address - Fax:302-475-4608
Practice Address - Street 1:1805 FOULK RD
Practice Address - Street 2:SUITE #E
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3700
Practice Address - Country:US
Practice Address - Phone:302-475-0500
Practice Address - Fax:302-475-4608
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0001894208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000026701Medicaid
DE256946OtherBCBS DE
DE256946OtherBCBS DE