1699769554 NPI number — COLLINS P SEIN MD

Table of content: COLLINS P SEIN MD (NPI 1699769554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699769554 NPI number — COLLINS P SEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIN
Provider First Name:
COLLINS
Provider Middle Name:
P
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:
1699769554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1558
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20604-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-638-9670
Provider Business Mailing Address Fax Number:
301-638-7558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3460 OLD WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 203A
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20602-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-934-8811
Provider Business Practice Location Address Fax Number:
301-934-9321
Provider Enumeration Date:
09/07/2005

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: 207R00000X , with the licence number:  D0046979 , 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: F2470001 . This is a "BLUE CROSS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 293041 . This is a "MAMSI, ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 431203100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KAF9SO . This is a "BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 110237779 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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