Provider Demographics
NPI:1538852686
Name:KONGARA, AKHILA (MD)
Entity type:Individual
Prefix:MRS
First Name:AKHILA
Middle Name:
Last Name:KONGARA
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:VIRTUA OUR LADY OF LOURDES HOSPITAL
Mailing Address - Street 2:1600 HADDON AVE CAMDEN NEW JERSEY
Mailing Address - City:NEW JERSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:856-757-3500
Mailing Address - Fax:856-886-6061
Practice Address - Street 1:VIRTUA OUR LADY OF LOURDES HOSPITAL
Practice Address - Street 2:1600 HADDON AVE CAMDEN NEW JERSEY
Practice Address - City:NEW JERSEY
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-757-3500
Practice Address - Fax:856-886-6061
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2024-02-01
Deactivation Date:2024-01-05
Deactivation Code:
Reactivation Date:2024-01-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program