MEDICARE: AJAY KOLLI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	D0106518	MD

General Provider Information

NPI Number	:	1396494118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJAY KOLLI MD

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-955-5000
Fax Number	:	410-500-4266

Provider Business Practice Location Address
First Line	:	4940 EASTERN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-2735
Country	:	US
Telephone Number	:	410-550-5568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2022
Last Update Date	:	05/28/2026

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