Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 023184 | CT |
N | 207RG0100X | Gastroenterologist | 290596 | MA |
NPI | 1043201924 |
---|---|
Provider Name | Kolala Ramakrishnasastry Sridhar |
First Address | Norwich, CT 06360-2146 |
Second Address | Rocky Hill, CT 06067-2336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 18/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010023184CT02 | ANTHEM BCBS CT (01) | CT |
030206 | HEALTHNET NE (01) | CT |
2543540 | AETNA HMO (01) | CT |
4383009 | AETNA PPO (01) | CT |
611709 | CONNECTICARE (01) | CT |
NLS073 | OXFORD (01) | CT |