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Individual

SUSMITHA P. KOLLI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1500 E MAIN ST, LANCASTER, OH 43130-3478
(740) 653-3527
(740) 356-3509
Mailing address
1500 E MAIN ST, LANCASTER, OH 43130-3478
(740) 653-3527
(740) 356-3509

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35-06-8263-K
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000121711
ANTHEM
OH
01
0800909
UNITED HEALTH CARE
OH
01
13442
NATIONWIDE
OH
01
1529613
UNITED MINE WORKERS
OH
05
2021618
OH
01
21149410544-01
CAPP CARE
OH
01
311551850-00
WORKERS COMPENSATION
OH
01
311551850-001
PRUDENTIAL
OH
01
311551850002
CIGNA
OH
01
358452379
TRICARE
OH
01
40888
MEDIGOLD
OH
01
5423505
AETNA
OH
01
990006614
RAILROAD MEDICARE
OH
Enumeration date
10/18/2005
Last updated
01/16/2017
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