Healthcare Provider Details

I. General information

NPI: 1497722375
Provider Name (Legal Business Name): VENKATA S. K. KOLLIPARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELMONT AVE
YOUNGSTOWN OH
44504-1003
US

IV. Provider business mailing address

1001 BELMONT AVE
YOUNGSTOWN OH
44504-1003
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-1106
  • Fax: 330-747-0491
Mailing address:
  • Phone: 330-747-1106
  • Fax: 330-747-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.046028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: