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Individual

PAVAN KOLLURI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
204 TALCOTT RIDGE RD, SOUTH WINDSOR, CT 06074-2394
(860) 648-4032
(260) 407-8004
Mailing address
204 TALCOTT RIDGE RD, SOUTH WINDSOR, CT 06074-2394
(860) 648-4032
(260) 407-8004

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
36831
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
64036676
KY
01
930109200
RAILROAD
KY
Enumeration date
07/09/2006
Last updated
10/15/2008
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