Organization
REVATHI KOTLA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REVATHI KOTLA MD (OWNER)
(973) 758-1650
Entity
Organization
Contact information
Practice address
623 EAGLE ROCK AVE, WEST ORANGE, NJ 07052-2948
(973) 736-0687
Mailing address
61 JOANNA WAY, SHORT HILLS, NJ 07078-3206
(973) 758-1650
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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