Provider Demographics
NPI:1457370330
Name:KOTHARI, NEHA (MD)
Entity type:Individual
Prefix:
First Name:NEHA
Middle Name:
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:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0733
Mailing Address - Country:US
Mailing Address - Phone:301-663-4357
Mailing Address - Fax:
Practice Address - Street 1:9 COTSWOLD LN
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-6900
Practice Address - Country:US
Practice Address - Phone:610-770-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ650392085R0202X
PAMD071312L2085R0202X
NJ25MA065039002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001865335Medicaid
NJ69479Medicare ID - Type Unspecified