Provider Demographics
NPI:1043201924
Name:SRIDHAR, KOLALA R (MD)
Entity type:Individual
Prefix:
First Name:KOLALA
Middle Name:R
Last Name:SRIDHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KOLALA
Other - Middle Name:RAMAKRISHNASASTRY
Other - Last Name:SRIDHAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:BERKSHIRE MEDICAL CENTER
Mailing Address - Street 2:725 NORTH STREET
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-417-2000
Mailing Address - Fax:860-886-9771
Practice Address - Street 1:BERKSHIRE MEDICAL CENTER
Practice Address - Street 2:725 NORTH STREET
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-447-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA290596207RG0100X
CT023184207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT030206OtherHEALTHNET NE
CTNLS073OtherOXFORD
CT2543540OtherAETNA HMO
CT010023184CT02OtherANTHEM BCBS CT
CT4383009OtherAETNA PPO
CT611709OtherCONNECTICARE
CT611709OtherCONNECTICARE
CT2543540OtherAETNA HMO
CTNLS073OtherOXFORD