Provider Demographics
NPI:1740586536
Name:RAJA KOLISETTI
Entity Type:Organization
Organization Name:RAJA KOLISETTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
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:585-591-6962
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:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty