Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D74006 | MD |
Y | 111NI0900X | Internist | D74006 | MD |
NPI | 1003061060 |
---|---|
Provider Name | Dr. Susrutha Kotwal |
First Address | Baltimore, MD 21264-4264 |
Second Address | Baltimore, MD 21224-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 09/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
365112600 | (05) | MD |