Provider Demographics
NPI:1225001514
Name:MURTHY, KOLLEGAL SREENIVASA (MD)
Entity Type:Individual
Prefix:DR
First Name:KOLLEGAL
Middle Name:SREENIVASA
Last Name:MURTHY
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 1:299 CAREW ST
Mailing Address - Street 2:STE 222
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2458
Mailing Address - Country:US
Mailing Address - Phone:413-739-4085
Mailing Address - Fax:413-733-3646
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:STE 222
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-739-4085
Practice Address - Fax:413-733-3646
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56320207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000006165OtherHEALTHNET
056320OtherTUFTS
484102OtherCONNECTICARE
0520870OtherCIGNA
MAH11011OtherBLUE CROSS BLUE SHIELD
9192OtherHARVARD PILGRIM
14651OtherHEALTH NEW ENGLAND
MA2046865Medicaid
S007632OtherCHAMPUS
14651OtherHEALTH NEW ENGLAND
S007632OtherCHAMPUS