Provider Demographics
NPI:1073501987
Name:COLLINS, INYANGA (MD)
Entity Type:Individual
Prefix:
First Name:INYANGA
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3425 N CARLISLE ST
Mailing Address - Street 2:2ND FL HUDSON BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5108
Mailing Address - Country:US
Mailing Address - Phone:215-707-4739
Mailing Address - Fax:215-707-3677
Practice Address - Street 1:3322 N BROAD ST
Practice Address - Street 2:2ND FL CANCER CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5185
Practice Address - Country:US
Practice Address - Phone:215-707-4600
Practice Address - Fax:215-707-3644
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD062273L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016602850002Medicaid
G61666Medicare UPIN
PA0016602850002Medicaid