NPI 1154599132

Pothen Koruth MD LLC

Organisation Exclusive Provider Organization Lake Mary, FL

Practice location

Address: 758 N Sun Dr, Lake Mary, FL 32746-2599
Phone: (407) 333-3303
Fax: (407) 333-3342

Authorised official

Name: Carolyn Victoria Brown
Title: Office Manager
Phone: (407) 333-3303

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1154599132
Entity type: Organization
NPI issued: 13 Feb 2008
Record last updated: 13 Feb 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.