Provider Demographics
NPI:1033279583
Name:COLLINS, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 DAVENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2601
Mailing Address - Country:US
Mailing Address - Phone:914-967-9383
Mailing Address - Fax:
Practice Address - Street 1:420 NORTH AVE
Practice Address - Street 2:NEW ROCHELLE SERVICES OF RPC SECOND FLOOR
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4160
Practice Address - Country:US
Practice Address - Phone:914-633-8842
Practice Address - Fax:914-633-8947
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1463842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13D423OtherBC BS HOSPITAL
NY13D422OtherBC BS PRIVATE PRACTICE
NYD41784Medicare UPIN