Provider Demographics
NPI:1548367006
Name:KOOTA, DAVID H (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:KOOTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 MONROE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502
Mailing Address - Country:US
Mailing Address - Phone:908-431-0992
Mailing Address - Fax:
Practice Address - Street 1:579A CRANBURY RD STE 105
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5426
Practice Address - Country:US
Practice Address - Phone:732-390-8700
Practice Address - Fax:732-390-8555
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA65601173000000X
NJ25MA06560100208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJK0951438Medicare ID - Type Unspecified
NJG53395Medicare UPIN