Provider Demographics
NPI:1679986681
Name:ATTICA FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:ATTICA FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLISETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-591-6000
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14021-0333
Mailing Address - Country:US
Mailing Address - Phone:585-591-6000
Mailing Address - Fax:585-489-2622
Practice Address - Street 1:107 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1149
Practice Address - Country:US
Practice Address - Phone:585-591-6000
Practice Address - Fax:585-591-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty