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Individual

MR. VIJAYASIMHA KOTHA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
312 KING STREET, OGDENSBURG, NY 13669
(315) 393-1144
(315) 393-1476
Mailing address
P.O. BOX 156, 312 KING STREET, OGDENSBURG, NY 13669-1195
(315) 393-1144
(315) 393-1476

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
1140931
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00500587
NY
Enumeration date
11/08/2006
Last updated
01/06/2011
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