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General NPI Number Information
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NPI Number | 1669349593
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Entity Type | Organization
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Legal Business Name | SUSMITHA P. KOLLI MD, LLC
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 1500 E MAIN ST STE 2D
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City | LANCASTER
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State | OH
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Zip | 43130-3478
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Country | US
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Telephone | 740-653-3527
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Fax | 740-653-3509
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Provider Business Mailing Address
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Address Line | 1500 E MAIN ST STE 2D
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City | LANCASTER
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State | OH
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Zip | 43130-3478
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Country | US
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Telephone | 740-653-3527
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Fax | 740-653-3509
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Authorized Official
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Title or Position | OWNER
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Name | SUSMITHA PINNAMANENI KOLLI
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Credential | MD
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Telephone | 740-653-3527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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