Revathi Kotla MD PC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

REVATHI KOTLA MD PC

Practice address

623 Eagle Rock Ave
West Orange, NJ 07052-2948

Phone

(973) 736-0687

NPI assigned

Oct 29, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Revathi Kotla, MDNPI 1063506434

Title

Owner

Phone

(973) 758-1650

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Revathi Kotla, MD

  • Nephrology Physician
  • Short Hills, NJ
  • NPI 1063506434
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540771200000",
    "number": "1609343672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 JOANNA WAY",
            "city": "SHORT HILLS",
            "state": "NJ",
            "postal_code": "070783206",
            "telephone_number": "973-758-1650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 EAGLE ROCK AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522948",
            "telephone_number": "973-736-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVATHI KOTLA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-29",
        "last_updated": "2018-10-29",
        "status": "A",
        "authorized_official_last_name": "KOTLA",
        "authorized_official_first_name": "REVATHI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-758-1650",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Nephrology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.