Provider Demographics
NPI:1720154198
Name:BOLLEPALLI, SUBBARAO (MD)
Entity type:Individual
Prefix:DR
First Name:SUBBARAO
Middle Name:
Last Name:BOLLEPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BOLLEPALLI
Other - Middle Name:
Other - Last Name:SUBARRAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:97 BARNES RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1885
Mailing Address - Country:US
Mailing Address - Phone:203-679-5605
Mailing Address - Fax:203-235-7413
Practice Address - Street 1:97 BARNES RD
Practice Address - Street 2:SUITE #2
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1885
Practice Address - Country:US
Practice Address - Phone:203-679-5605
Practice Address - Fax:203-235-7413
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0211822084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD02906Medicare UPIN