1326232208 NPI number — COLLETTE MEHRING D.O.

Table of content: COLLETTE MEHRING D.O. (NPI 1326232208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326232208 NPI number — COLLETTE MEHRING D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHRING
Provider First Name:
COLLETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1326232208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4923 OGLETOWN STANTON RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-2081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-225-0451
Provider Business Mailing Address Fax Number:
302-225-0472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 W HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921-8604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-620-9200
Provider Business Practice Location Address Fax Number:
410-620-9207
Provider Enumeration Date:
09/04/2007

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: 207RN0300X , with the licence number:  C2-0008875 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: H0067854 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0183911 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326232208 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4164300 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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