Provider Demographics
NPI:1104051200
Name:BOTT, KRISTA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:BOTT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTH SYSTEM - PROFESSIONAL CENTER
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4919
Mailing Address - Fax:570-426-2643
Practice Address - Street 1:600 COMMERCE BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6214
Practice Address - Country:US
Practice Address - Phone:570-426-6070
Practice Address - Fax:570-422-8091
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2023-05-04
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Provider Licenses
StateLicense IDTaxonomies
PAMT194819208600000X
PAMD451073208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery