Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD428725 | PA |
N | 208200000X | Surgeon | MD428725 | PA |
N | 208600000X | Surgeon | MD428725 | PA |
NPI | 1306885017 |
---|---|
Provider Name | Dr. Anil Kotru |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 21/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1016388210001 | (05) | PA |
I53563 | (02) |