Provider Demographics
NPI:1174503205
Name:KOLLA, SAIRAMACHANDRA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SAIRAMACHANDRA
Middle Name:RAO
Last Name:KOLLA
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 1:2757 JOHN F KENNEDY BLVD 1ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5507
Mailing Address - Country:US
Mailing Address - Phone:201-333-8004
Mailing Address - Fax:201-333-8425
Practice Address - Street 1:2757 KENNEDY BLVD
Practice Address - Street 2:1ST FL
Practice Address - City:JERSHEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5507
Practice Address - Country:US
Practice Address - Phone:201-333-8004
Practice Address - Fax:201-333-8425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234221208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation