Provider Demographics
NPI:1063477107
Name:MAHAR, COLLEEN P (PA)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:P
Last Name:MAHAR
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2105 BRAXTON LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2801
Mailing Address - Country:US
Mailing Address - Phone:336-333-6306
Mailing Address - Fax:336-333-6309
Practice Address - Street 1:2105 BRAXTON LN
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2861
Practice Address - Country:US
Practice Address - Phone:336-333-6306
Practice Address - Fax:336-333-6309
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103466363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC196837OtherMEDCOST
NCP63339Medicare UPIN
NC2755931AMedicare PIN