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Individual

FREDERICK KOTALIK

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
130 SOUTH BRYN MAWR AVENUE, BRYN MAWR, PA 19010
(610) 526-3583
(610) 526-3614
Mailing address
PO BOX 3012, WILMINGTON, DE 19804
(800) 456-4629
(302) 224-2848

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD044433L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0012667790001
PA
Enumeration date
02/16/2006
Last updated
07/08/2007
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