Healthcare Provider Details

I. General information

NPI: 1497598577
Provider Name (Legal Business Name): AKSHARA KOTHAPALLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 M ST NW STE 450
WASHINGTON DC
20005-1726
US

IV. Provider business mailing address

600 GRAVEL BROOK CT
CARY NC
27519-6008
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 919-518-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1219612
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: