Provider Demographics
NPI:1497195390
Name:KOTHARI, RAVISH ASHOKKUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAVISH
Middle Name:ASHOKKUMAR
Last Name:KOTHARI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:803-434-6412
Mailing Address - Fax:
Practice Address - Street 1:8 MED PARK STE 420
Practice Address - Street 2:NEUROLOGY
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-545-6072
Practice Address - Fax:803-545-6051
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC359092084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC359098Medicaid