1366598898 NPI number — ANDRE S COLACO MD

Table of content: ANDRE S COLACO MD (NPI 1366598898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366598898 NPI number — ANDRE S COLACO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLACO
Provider First Name:
ANDRE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1366598898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 DEFENSE HWY
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-897-9841
Provider Business Mailing Address Fax Number:
410-897-9852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 DEFENSE HWY STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-897-9841
Provider Business Practice Location Address Fax Number:
410-897-9852
Provider Enumeration Date:
01/26/2007

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: 207R00000X , with the licence number:  D0067263 , 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)

  • Identifier: 039732900 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145724700 . This is a "FEDERAL WORKMAN'S COMP DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4157249 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: S3990051 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1917064 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9269182 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 277001 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 219448 . This is a "JOHNS HOPKINS HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: KJ77AN9398801 . This is a "CAREFIRST MARYLAND" identifier . This identifiers is of the category "OTHER".




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