Provider Demographics
NPI:1275685794
Name:HOLLA, SUHRUTHA (MD)
Entity Type:Individual
Prefix:
First Name:SUHRUTHA
Middle Name:
Last Name:HOLLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3735
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:14 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3003
Practice Address - Country:US
Practice Address - Phone:508-473-1190
Practice Address - Fax:508-482-5416
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA233295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000271002Medicare PIN