Provider Demographics
NPI:1255891586
Name:KOLLA, KANTHA RATNAM (MD)
Entity type:Individual
Prefix:
First Name:KANTHA RATNAM
Middle Name:
Last Name:KOLLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3246
Mailing Address - Country:US
Mailing Address - Phone:225-752-2470
Mailing Address - Fax:225-755-4998
Practice Address - Street 1:17000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3246
Practice Address - Country:US
Practice Address - Phone:225-752-2470
Practice Address - Fax:225-755-4998
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA329926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine