1568796662 NPI number — ANELA MICHELLE COLLAZO PA-C

Table of content: ANELA MICHELLE COLLAZO PA-C (NPI 1568796662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568796662 NPI number — ANELA MICHELLE COLLAZO PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLAZO
Provider First Name:
ANELA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1568796662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 OLD WESTMINSTER PIKE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-6267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-871-6864
Provider Business Mailing Address Fax Number:
410-871-6226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
844 WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-6664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-871-0088
Provider Business Practice Location Address Fax Number:
410-871-0083
Provider Enumeration Date:
09/23/2009

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: 363AS0400X , with the licence number:  C0003833 , 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)





Copyright © 2007-2025 www.npivalidator.com