Individual
MADHU K KOLLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
828 HEALTHY WAY STE 270, VIRGINIA BEACH, VA 23462-7959
(757) 623-0005
(757) 389-5383
Mailing address
4445 CORPORATION LN STE 100, VIRGINIA BEACH, VA 23462-3666
(757) 623-0005
(757) 548-1129
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101232981
VA
207RN0300X
Nephrology Physician
Primary
0101232981
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005875889
—
VA
01
—
103251
BLUE CROSS BLUE SHEILD
VA
Enumeration date
11/21/2005
Last updated
01/20/2022
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