Provider Demographics
NPI:1134252232
Name:SUDHA KOLLI MD PA
Entity type:Organization
Organization Name:SUDHA KOLLI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-249-2044
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920
Mailing Address - Country:US
Mailing Address - Phone:732-249-2044
Mailing Address - Fax:908-253-0053
Practice Address - Street 1:330 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-249-2044
Practice Address - Fax:732-249-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2075976001OtherKEYSTONE
28658OtherUNIVERSITY HEALTH PLAN
01000598201OtherAMERICHOICE
1165329OtherHORIZON NJ HEALTH
P2212167OtherOXFORD
2K0392OtherHEALTHNET
NJ8181705Medicaid
2K0392OtherHEALTHNET
NJ8181705Medicaid