NPIMap

Individual provider Active NPI

Sophia Kotliar, M.D.

  • Clinical Pathology/Laboratory Medicine Physician
  • Elkton, MD
National Provider Identifier
1699775395
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X
License
C10004615 Issued in DE
Practice address
106 Bow St
Department of Pathology
Elkton, MD 21921-5544
Phone
(443) 674-1289
NPI assigned
Jul 26, 2005
Last updated
Apr 19, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X C10004615 DE Primary

Addresses

Primary practice location

106 Bow St
Department of Pathology
Elkton, MD 21921-5544

Mailing address

640 S State St
Dover, DE 19901-3530
Phone (302) 744-7050

Other identifiers 1

IdentifierTypeStateIssuer
0018052100002MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190409000620 NJ Practitioner - Pathology 6305733809 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meridian Laboratory Physicians, PAGroup PAC ID 5193707032, 20 clinicians

Practice addresses (Care Compare)

1 Riverview PLZ
Red Bank, NJ 07701-1864
Phone (732) 741-2700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C10004615DEMDClinical Pathology/Laboratory Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Meridian Laboratory Physicians PA CurrentSince Mar 5, 2019 Accepting new patients
Atlantic Coast Urology,PA CurrentSince Jan 1, 2022 Accepting new patients
Raso - Cohen Gastroenterology Associates, Inc CurrentSince Apr 15, 2023 Accepting new patients
Himansh Khanna, MD, PC PastSince Jan 1, 2022 Accepting new patients

Locations

727 N Beers St
Holmdel, NJ 07733
Phone (732) 714-2700

1944 Corlies Ave
Ste 101
Neptune, NJ 07753
Phone (732) 775-8444

1 Riverview Plz
Red Bank, NJ 07701
Phone (732) 530-2204

1140 Route 72 W
Stafford Township, NJ 08050
Phone (609) 978-2194

129 Route 37 W
Ste 3
Toms River, NJ 08755
Phone (732) 797-3990

129 Route 37 W
Ste 4
Toms River, NJ 08755
Phone (732) 240-0599

1945 State Route 33
Wall Township, NJ 07753
Phone (732) 776-2333

425 Jack Martin Blvd
Wall Township, NJ 08724
Phone (732) 840-2200

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/1d6c3167-ceed-47b0-b6f7-156a9cb2ffbe/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492560000000",
    "number": "1699775395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 S STATE ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013530",
            "telephone_number": "302-744-7050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 BOW ST",
            "address_2": "DEPARTMENT OF PATHOLOGY",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215544",
            "telephone_number": "443-674-1289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTLIAR",
        "first_name": "SOPHIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-26",
        "last_updated": "2017-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "DE",
            "license": "C10004615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018052100002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkton, MD

Sources for this page

Verify at the official NPI Registry.