Provider Demographics
NPI:1043501646
Name:KOTCHEV, NICOLA PETROV (MD)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:PETROV
Last Name:KOTCHEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 BAINBRIDGE AVE
Mailing Address - Street 2:MAP8
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2404
Mailing Address - Country:US
Mailing Address - Phone:718-920-8888
Mailing Address - Fax:718-653-4048
Practice Address - Street 1:3400 BAINBRIDGE AVE
Practice Address - Street 2:MAP8
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-8888
Practice Address - Fax:718-653-4048
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY274463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03972561Medicaid