Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 27587 | AL |
N | 111NI0900X | Internist | 27587 | AL |
N | 207RC0000X | Internist - Cardiovascular Disease | 204177 | LA |
Y | 207RI0011X | Interventional Cardiology | 204177 | LA |
NPI | 1093903726 |
---|---|
Provider Name | Dr. Koteswara R Pothineni |
First Address | New Orleans, LA 70121-2429 |
Second Address | Baton Rouge, LA 70808-4370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08154048 | (05) | MS |
2107364 | (05) | LA |
351459YUST | MEDICARE PTAN (01) | LA |
BP9967538 | DEA (01) | AL |