Provider Demographics
NPI:1639108285
Name:KOLISETTY, PRAMILA KUMARI (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAMILA
Middle Name:KUMARI
Last Name:KOLISETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAK WAY
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1415
Mailing Address - Country:US
Mailing Address - Phone:718-644-4529
Mailing Address - Fax:718-684-2518
Practice Address - Street 1:2940 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2611
Practice Address - Country:US
Practice Address - Phone:718-684-2516
Practice Address - Fax:718-684-2518
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240104208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240104OtherLICENSE
NY240104OtherLICENSE
BK9578913OtherDEA
06137392OtherECFMG