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NPI Code Detail

MEDICARE: MADHU K KOLLI MD

MEDICARE: MADHU K KOLLI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician0101232981VA
2207RN0300XNephrology Physician0101232981VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103251OTHERVABLUE CROSS BLUE SHEILD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114900552
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADHU K KOLLI MD
Provider Business Mailing Address
First Line : 4445 CORPORATION LN STE 100
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-3666
Country : US
Telephone Number : 757-623-0005
Fax Number : 757-548-1129
Provider Business Practice Location Address
First Line : 828 HEALTHY WAY STE 270
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-7959
Country : US
Telephone Number : 757-623-0005
Fax Number : 757-389-5383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 01/20/2022

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