Provider Demographics
NPI:1669349593
Name:SUSMITHA P. KOLLI MD, LLC
Entity type:Organization
Organization Name:SUSMITHA P. KOLLI MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSMITHA
Authorized Official - Middle Name:PINNAMANENI
Authorized Official - Last Name:KOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-653-3527
Mailing Address - Street 1:1500 E MAIN ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3478
Mailing Address - Country:US
Mailing Address - Phone:740-653-3527
Mailing Address - Fax:740-653-3509
Practice Address - Street 1:1500 E MAIN ST STE 2D
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3478
Practice Address - Country:US
Practice Address - Phone:740-653-3527
Practice Address - Fax:740-653-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty