Provider Demographics
NPI:1053475178
Name:HSU, COLLEEN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:Y
Last Name:HSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YUHONG
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6705 N CLIPPINGER DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-3206
Mailing Address - Country:US
Mailing Address - Phone:513-272-8633
Mailing Address - Fax:
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-475-6317
Practice Address - Fax:513-475-6399
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4213501Medicare PIN
OHP00415722Medicare PIN