Provider Demographics
NPI:1699775395
Name:KOTLIAR, SOPHIA (MD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:KOTLIAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-744-7050
Mailing Address - Fax:
Practice Address - Street 1:106 BOW ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5544
Practice Address - Country:US
Practice Address - Phone:443-674-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004615207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018052100002Medicaid
DEG21739Medicare UPIN
PA0018052100002Medicaid
22008340Medicare PIN
PA038969N6UMedicare PIN