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Individual

SRINIVAS KOLLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
450 CLARKSON AVE, DEPT OF RADIOLOGY BOX 1198, BROOKLYN, NY 11203-2056
(718) 270-7378
Mailing address
450 CLARKSON AVE, DEPT OF RADIOLOGY BOX 1198, BROOKLYN, NY 11203-2012
(718) 270-1603

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
238079
NY
2085R0202X
Diagnostic Radiology Physician
A93364
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A933640
MEDICAL
CA
01
02321093
NY MEDICAID (GROUP)
NY
05
02931946
NY
Enumeration date
06/13/2006
Last updated
07/30/2013
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