Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 0102203803 | VA |
Y | 207RA0401X | Internist - Addiction Medicine | 020055262A | IN |
N | 207RA0401X | Internist - Addiction Medicine | 021805 | LA |
NPI | 1053439489 |
---|---|
Provider Name | Dr. John Robert Colaluca |
First Address | Richmond, VA 23285-5050 |
Second Address | Greenwood, IN 46143-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 24/04/2018 |