Healthcare Provider Details

I. General information

NPI: 1316979305
Provider Name (Legal Business Name): PADMAJA KOLACHANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12931 OAK HILL AVE
HAGERSTOWN MD
21742-2914
US

IV. Provider business mailing address

12931 OAK HILL AVE
HAGERSTOWN MD
21742-2914
US

V. Phone/Fax

Practice location:
  • Phone: 301-797-9600
  • Fax: 301-797-3854
Mailing address:
  • Phone: 301-797-9600
  • Fax: 301-797-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD494900
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0106015
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number36535
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: