Provider Demographics
NPI:1518656891
Name:KALOLA, AMI VIJAY
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:VIJAY
Last Name:KALOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PROMENADE PL
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4170
Mailing Address - Country:US
Mailing Address - Phone:856-266-0222
Mailing Address - Fax:
Practice Address - Street 1:32 PROMENADE PLACE
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4170
Practice Address - Country:US
Practice Address - Phone:856-266-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program