1386641116 NPI number — MICHAEL JOHN COLLI M.D.

Table of content: MICHAEL JOHN COLLI M.D. (NPI 1386641116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386641116 NPI number — MICHAEL JOHN COLLI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLI
Provider First Name:
MICHAEL
Provider Middle Name:
JOHN
Provider Name Prefix Text:
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:
1386641116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CHAMBERS HILL DR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
CHAMBERSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17201-7304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-709-7922
Provider Business Mailing Address Fax Number:
717-263-2055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-263-0550
Provider Business Practice Location Address Fax Number:
717-263-8898
Provider Enumeration Date:
07/07/2005

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: 208000000X , with the licence number:  MD073663L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001853183 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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