1205923737 NPI number — DR. ANDREW RICHARD COLLINS DPM

Table of content: DR. ANDREW RICHARD COLLINS DPM (NPI 1205923737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205923737 NPI number — DR. ANDREW RICHARD COLLINS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
ANDREW
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
ANDREW
Provider Other Middle Name:
RICHARD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205923737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17021 OLD ORCHARD RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-4832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-644-8008
Provider Business Mailing Address Fax Number:
302-644-6883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17021 OLD ORCHARD RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-8008
Provider Business Practice Location Address Fax Number:
302-644-6883
Provider Enumeration Date:
10/06/2006

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: 213E00000X , with the licence number:  E10000147 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: SC004403L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2122055 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50184 . This is a "MID ATLANTIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2245531000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 211052 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00148040 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000027199 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1319436 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1565980 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com