1265533293 NPI number — REBECCA JANE COLLMAN M.D.

Table of content: REBECCA JANE COLLMAN M.D. (NPI 1265533293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265533293 NPI number — REBECCA JANE COLLMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLMAN
Provider First Name:
REBECCA
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCMAHON
Provider Other First Name:
REBECCA
Provider Other Middle Name:
COLLMAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265533293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
164 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
COLCHESTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05446-7168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-878-7844
Provider Business Mailing Address Fax Number:
802-872-9667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
164 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
COLCHESTER
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05446-7168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-878-7844
Provider Business Practice Location Address Fax Number:
802-872-9667
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  420007780 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 415510 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 9919 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1002884 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26V031 . This is a "MVP HEALTHCARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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