Individual
SUREKHA VENKATA KOTAPOTHULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4TH AND WALNUT STREETS, 3RD FLOOR, LEBANON, PA 17042-6123
(717) 270-4876
(717) 270-3875
Mailing address
PO BOX 300, LEBANON, PA 17042-0300
(717) 270-7780
(717) 274-9746
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD437413
PA
208M00000X
Hospitalist Physician
Primary
MD437413
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102327998 0004
—
PA
Enumeration date
01/14/2008
Last updated
02/25/2020
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