Provider Demographics
NPI:1891706834
Name:KOLLIPARA, MADHU S (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:S
Last Name:KOLLIPARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1006
Mailing Address - Country:US
Mailing Address - Phone:330-480-3258
Mailing Address - Fax:330-480-4119
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-480-3258
Practice Address - Fax:330-480-4119
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6239207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191027503Medicaid
TX191027501Medicaid
TX191027504Medicaid
TX191027504Medicaid
TX191027503Medicaid
TXTXB166907Medicare PIN
TXTXB153887Medicare PIN
TX8J6770Medicare PIN