Individual
DR. SHYAMASUNDARAN KOTTILIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 706-4613
(410) 706-4619
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4441
(410) 706-4613
(410) 706-4619
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101232128
MD
207R00000X
Internal Medicine Physician
MD037944
DC
207RI0200X
Infectious Disease Physician
Primary
D78371
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S062-0561
CAREFIRST B/C B/S
MD
Enumeration date
07/14/2009
Last updated
12/01/2014
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