Provider Demographics
NPI:1235136672
Name:GOLLAPALLI, USHA (MD)
Entity type:Individual
Prefix:MRS
First Name:USHA
Middle Name:
Last Name:GOLLAPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 MONTROSE RD
Mailing Address - Street 2:WASSERMAN BUILDING/MEDICAL DEPARTMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-770-8377
Mailing Address - Fax:301-816-7716
Practice Address - Street 1:785 ELKRIDGE LANDING RD STE 300
Practice Address - Street 2:
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090-2958
Practice Address - Country:US
Practice Address - Phone:443-323-3014
Practice Address - Fax:855-212-5249
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403922000Medicaid
MDI03996Medicare UPIN
MD403922000Medicaid