1508842030 NPI number — LAWRENCE COLLINS M.D.

Table of content: LAWRENCE COLLINS M.D. (NPI 1508842030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508842030 NPI number — LAWRENCE COLLINS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
LAWRENCE
Provider Middle Name:
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:
1508842030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 STONEWOOD DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090-8317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-934-5520
Provider Business Mailing Address Fax Number:
724-934-5533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 STONEWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-8317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-934-5520
Provider Business Practice Location Address Fax Number:
724-934-5533
Provider Enumeration Date:
12/16/2005

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: 208800000X , with the licence number:  MD010585E , 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: 00684030 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147808 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 13567 . This is a "ELDER HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102503 . This is a "102503" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0335399002 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 077398 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com