Provider Demographics
NPI:1023222734
Name:COLLIE, CYNTHIA E (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:COLLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:E
Other - Last Name:COLLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:SULLIVANS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29482-0187
Mailing Address - Country:US
Mailing Address - Phone:843-883-9030
Mailing Address - Fax:
Practice Address - Street 1:306 STATION 22 AND A HALF
Practice Address - Street 2:
Practice Address - City:SULLINVANS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29482
Practice Address - Country:US
Practice Address - Phone:843-883-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16132207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC161327Medicaid
SCF73138Medicare UPIN