Provider Demographics
NPI:1033552724
Name:VICTORY, COLLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:VICTORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SUPERIOR AVE E
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2614
Mailing Address - Country:US
Mailing Address - Phone:216-337-1622
Mailing Address - Fax:
Practice Address - Street 1:600 SUPERIOR AVE E
Practice Address - Street 2:SUITE 2400
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2614
Practice Address - Country:US
Practice Address - Phone:216-337-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069335207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine