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NPI Code Detail

MEDICARE: DR. PRASHANTA BHARADWAJA KOLLURU M.D.

MEDICARE: DR. PRASHANTA BHARADWAJA KOLLURU 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
1390200000XStudent in an Organized Health Care Education/Training ProgramNY
2207R00000XInternal Medicine Physician0101255970VA

General Provider Information

NPI Number : 1629353115
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRASHANTA BHARADWAJA KOLLURU M.D.
Provider Business Mailing Address
First Line : 1602 SKIPWITH RD
Second Line :
City : RICHMOND
State : VA
Zip : 23229-5298
Country : US
Telephone Number : 804-289-4500
Fax Number :
Provider Business Practice Location Address
First Line : 1602 SKIPWITH RD
Second Line :
City : RICHMOND
State : VA
Zip : 23229-5298
Country : US
Telephone Number : 804-289-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2011
Last Update Date : 06/01/2023

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