1255305074 NPI number — DR. STEVEN DONALD COLAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255305074 NPI number — DR. STEVEN DONALD COLAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

COLAN

Provider First Name:

STEVEN

Provider Middle Name:

DONALD

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1255305074

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/10/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 845628

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BOSTON

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

02284-5628

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

603-893-9784

Provider Business Mailing Address Fax Number:

603-893-8886

Provider First Line Business Practice Location Address:

300 LONGWOOD AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BOSTON

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

02115-5724

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

617-355-6793

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

02/16/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  45128 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0202X , with the licence number: 45128 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 30001169 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
• Identifier: 7500121 . This is a "UNITED HEALTHCARE MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 1098719 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 003054392 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 7610392 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: SC03665 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
• Identifier: 99254901 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: AA9210 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: B20086501 . This is a "CIGNA MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: E05286 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".