Individual
REVATHI KOTLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
61 JOANNA WAY, SHORT HILLS, NJ 07078-3206
(973) 758-1650
Mailing address
61 JOANNA WAY, SHORT HILLS, NJ 07078-3206
(973) 758-1650
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
325921
LA
207RN0300X
Nephrology Physician
Primary
MA64664
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7697805
—
NJ
Enumeration date
10/03/2006
Last updated
04/26/2021
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