Individual
RENU O KOTHARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
591 POQUONNOCK RD, GROTON, CT 06340-4571
(860) 449-8217
(860) 449-8323
Mailing address
591 POQUONNOCK RD, GROTON, CT 06340-4571
(860) 449-8217
(860) 449-8323
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
20325
CT
2084P0800X
Psychiatry Physician
5601
RI
2084P0804X
Child & Adolescent Psychiatry Physician
20325
CT
2084P0804X
Child & Adolescent Psychiatry Physician
MD05601
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008035572
—
CT
05
—
7001845
—
RI
Enumeration date
01/24/2006
Last updated
06/03/2019
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