Individual
CHANDRASEKHAR KOTHURU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22590 SHADY CT, CALIFORNIA, MD 20619-5009
(810) 262-7045
Mailing address
PO BOX 640, HOLLYWOOD, MD 20636-0640
(301) 373-7900
(301) 373-6900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D91038
MD
390200000X
Student in an Organized Health Care Education/Training Program
4301113156
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0091038
STATE LICENSE
MD
Enumeration date
07/13/2017
Last updated
12/09/2021
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