Provider Demographics
NPI:1487793204
Name:KOTY, PATRICK P (PHD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:P
Last Name:KOTY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170100000X
NC99079207SC0300X
NC2002055207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Not Answered207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
Not Answered207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics