Provider Demographics
NPI:1265431332
Name:KOTHARI, ASHOKKUMAR J (MD)
Entity type:Individual
Prefix:DR
First Name:ASHOKKUMAR
Middle Name:J
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 1:2223 W STATE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1938
Mailing Address - Country:US
Mailing Address - Phone:716-373-3544
Mailing Address - Fax:716-373-3546
Practice Address - Street 1:2223 W STATE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1938
Practice Address - Country:US
Practice Address - Phone:716-373-3544
Practice Address - Fax:716-373-3546
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY149078-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00828313Medicaid
NY003691OtherMEDICARE-ID
NY2103703OtherINDEPENDENT HEALTH
NY00010094201OtherUNIVERA
NY000500369001OtherBLUE CROSS NY
NY000056493OtherKEYSTONE BLUE
99007201OtherRR MEDICARE PIN
NY00010094201OtherUNIVERA
NY000500369001OtherBLUE CROSS NY