Provider Demographics
NPI:1487760518
Name:GOLLA, HARI (MD)
Entity type:Individual
Prefix:
First Name:HARI
Middle Name:
Last Name:GOLLA
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 1:70 DUBOIS STREET
Mailing Address - Street 2:ST LUKES CORNWALL HOSPITAL PATIENT ACCOUNTING DEPT
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-458-4927
Mailing Address - Fax:845-458-4970
Practice Address - Street 1:70 DUBOIS STREET
Practice Address - Street 2:ST LUKES CORNWALL HOSPITAL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-458-4927
Practice Address - Fax:845-458-4970
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I32706Medicare UPIN
NY306AL1Medicare ID - Type Unspecified