Provider Demographics
NPI:1144634833
Name:KOLLIPARA, VENKATESWARA KUMAR (MD)
Entity type:Individual
Prefix:
First Name:VENKATESWARA
Middle Name:KUMAR
Last Name:KOLLIPARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4852, GREENBRIER DR, GIRARD, YOUNGSTOWN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44420
Mailing Address - Country:US
Mailing Address - Phone:330-402-0421
Mailing Address - Fax:
Practice Address - Street 1:ST. ELIZABETH HEALTH CENTER, 1044 BELMONT AVE,
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44501-1790
Practice Address - Country:US
Practice Address - Phone:330-402-0421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH57.025031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program