1821317959 NPI number — DR. COLLEEN MICHELLE FORD M.D.

Table of content: DR. COLLEEN MICHELLE FORD M.D. (NPI 1821317959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821317959 NPI number — DR. COLLEEN MICHELLE FORD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORD
Provider First Name:
COLLEEN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1821317959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9142
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02129-9142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-887-3772
Provider Business Mailing Address Fax Number:
617-887-3707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 EVERETT AVENUE
Provider Second Line Business Practice Location Address:
CHELSEA HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02150-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-887-3772
Provider Business Practice Location Address Fax Number:
617-887-3707
Provider Enumeration Date:
05/28/2010

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:  244078 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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