Healthcare Provider Details

I. General information

NPI: 1720783392
Provider Name (Legal Business Name): AKSHITHA BRAMARA KOLLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 GROVE AVE STE A
VERONA NJ
07044-1731
US

IV. Provider business mailing address

250 RIDGEDALE AVE APT B8
FLORHAM PARK NJ
07932-1321
US

V. Phone/Fax

Practice location:
  • Phone: 973-239-2600
  • Fax:
Mailing address:
  • Phone: 703-895-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA13073400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: