1932336245 NPI number — KELLY A COLINGO MD

Table of content: KELLY A COLINGO MD (NPI 1932336245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932336245 NPI number — KELLY A COLINGO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLINGO
Provider First Name:
KELLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1932336245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE GI CREDENTIALING DEPARTMENT
Provider Second Line Business Mailing Address:
PO BOX 381468
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38183-1468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19455 DEERFIELD AVE STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSDOWNE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-8102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-723-3670
Provider Business Practice Location Address Fax Number:
877-325-2018
Provider Enumeration Date:
06/12/2009

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: 207L00000X , with the licence number:  2023-00985 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 0101057407 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1932336245 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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