Provider Demographics
NPI:1841492733
Name:KOTWAL, SHAVETA (MD)
Entity type:Individual
Prefix:
First Name:SHAVETA
Middle Name:
Last Name:KOTWAL
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 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:571-291-6131
Mailing Address - Fax:571-291-6135
Practice Address - Street 1:21170 ASHBY PONDS BLVD.
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:571-291-6131
Practice Address - Fax:571-291-6135
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244163207R00000X, 207RG0300X
NC2024-02927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
541908787004OtherTRICARE
1841492733OtherANTHEM BCBS
5374-0022OtherCAREFIRST BCBS
04-60195OtherEVERCARE
1841492733OtherANTHEM BCBS
00X972E01Medicare PIN