1336382712 NPI number — DR. MICHAEL TERRENCE COLLINS M.D.

Table of content: DR. MICHAEL TERRENCE COLLINS M.D. (NPI 1336382712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336382712 NPI number — DR. MICHAEL TERRENCE COLLINS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
MICHAEL
Provider Middle Name:
TERRENCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336382712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 CONVENT DR
Provider Second Line Business Mailing Address:
BUILDING 30, ROOM 228, MSC 4320
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20892-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-496-4913
Provider Business Mailing Address Fax Number:
301-402-0824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 CONVENT DR
Provider Second Line Business Practice Location Address:
BUILDING 30, ROOM 228, MSC 4320
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20892-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-496-4913
Provider Business Practice Location Address Fax Number:
301-402-0824
Provider Enumeration Date:
04/14/2009

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: 207RE0101X , with the licence number:  D0045237 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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