Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6726 | OH |
Y | 103TC0700X | Clinical Psychologist | 6726 | OH |
NPI | 1003110230 |
---|---|
Provider Name | Dr. David Kotarsky |
First Address | Bellaire, OH 43906-1547 |
Second Address | Bellaire, OH 43906-1547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2011 |
Last Update Date | 01/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3134021 | (05) | OH |
6726 | LICENSED PSYCHOLOGIST (01) | OH |
CP35441 | MEDICARE PTAN (01) | OH |