Provider Demographics
NPI:1992785083
Name:KOTHARI, RAKSHA A (MD)
Entity type:Individual
Prefix:DR
First Name:RAKSHA
Middle Name:A
Last Name:KOTHARI
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 1:2201 CHAPEL AVE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2048
Mailing Address - Country:US
Mailing Address - Phone:856-566-6845
Mailing Address - Fax:856-566-6906
Practice Address - Street 1:2201 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2048
Practice Address - Country:US
Practice Address - Phone:856-566-6845
Practice Address - Fax:856-566-6906
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA041488207R00000X
NJ25MA04148800208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6678203Medicaid
NJ110170805OtherRAILROAD MEDICARE
NJ801773AEDMedicare ID - Type Unspecified
NJ6678203Medicaid