Provider Demographics
NPI:1043391220
Name:MURTHY, KOLAR N (MD)
Entity Type:Individual
Prefix:
First Name:KOLAR
Middle Name:N
Last Name:MURTHY
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 1:2220 LYNN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1904
Mailing Address - Country:US
Mailing Address - Phone:805-495-6702
Mailing Address - Fax:805-495-6195
Practice Address - Street 1:2220 LYNN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1904
Practice Address - Country:US
Practice Address - Phone:805-495-6702
Practice Address - Fax:805-495-6195
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA251762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A251760Medicaid
A86856Medicare UPIN
CAA25176Medicare ID - Type Unspecified