Provider Demographics
NPI:1871751479
Name:POTHULA, ARAVIND (MD)
Entity type:Individual
Prefix:DR
First Name:ARAVIND
Middle Name:
Last Name:POTHULA
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 1:1625 POPLAR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2648
Practice Address - Country:US
Practice Address - Phone:718-405-8444
Practice Address - Fax:718-405-8345
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251279208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery