Provider Demographics
NPI:1811285646
Name:AKHIMIONA, COLLETTE (MD)
Entity type:Individual
Prefix:DR
First Name:COLLETTE
Middle Name:
Last Name:AKHIMIONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CONSHOHOCKEN AVE
Mailing Address - Street 2:# 313
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-5539
Mailing Address - Country:US
Mailing Address - Phone:405-808-5202
Mailing Address - Fax:
Practice Address - Street 1:230 N BROAD ST
Practice Address - Street 2:MS 345
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1121
Practice Address - Country:US
Practice Address - Phone:215-762-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT-200641207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine