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General NPI Number Information
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NPI Number | 1811285646
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Entity Type | Individual
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Provider Name | COLLETTE AKHIMIONA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 230 N BROAD ST MS 345
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1121
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Country | US
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Telephone | 215-762-7644
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 CONSHOHOCKEN AVE # 313
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City | PHILADELPHIA
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State | PA
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Zip | 19131-5539
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Country | US
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Telephone | 405-808-5202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MT-200641
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License Number State | PA
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