MEDICARE: DR. SUNIL VISHWANATH KOLOLGI M.D.,

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
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	0101042558	VA

General Provider Information

NPI Number	:	1336149343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUNIL VISHWANATH KOLOLGI M.D.,

Provider Business Mailing Address
First Line	:	7417 CLIFTON QUARRY DR
Second Line	:
City	:	CLIFTON
State	:	VA
Zip	:	20124-2810
Country	:	US
Telephone Number	:	703-930-1980
Fax Number	:	703-991-0051

Provider Business Practice Location Address
First Line	:	200 MEMORIAL DR
Second Line	:	PAGE MEMORIAL HOSPITAL
City	:	LURAY
State	:	VA
Zip	:	22835-1000
Country	:	US
Telephone Number	:	540-743-4561
Fax Number	:	540-743-1512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/08/2007

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