Individual
MADHUBALA A KOTHARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1860 TOWN CENTER DR, STE 210, RESTON, VA 20190-5905
(330) 455-0374
(330) 455-2101
Mailing address
1860 TOWN CENTER DR, STE 210, RESTON, VA 20190-5905
(330) 455-0374
(330) 455-2101
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101263835
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7610021
—
OH
Enumeration date
05/30/2006
Last updated
09/16/2019
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