1316940299 NPI number — DR. VENKATESWARA RAO KOLLI M.D.

Table of content: DR. VENKATESWARA RAO KOLLI M.D. (NPI 1316940299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316940299 NPI number — DR. VENKATESWARA RAO KOLLI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLLI
Provider First Name:
VENKATESWARA
Provider Middle Name:
RAO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOLLI
Provider Other First Name:
VENKAT
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1316940299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/16/2006
NPI Reactivation Date:
03/23/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4525 WITMER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14305-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-278-0873
Provider Business Mailing Address Fax Number:
716-278-0875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4525 WITMER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14305-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-278-0873
Provider Business Practice Location Address Fax Number:
716-278-0875
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  198308 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00665246 . This is a "MEDICARE OTHER" identifier . This identifiers is of the category "OTHER".