Provider Demographics
NPI:1114056793
Name:PEMA, COLLEEN M (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:PEMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N MURRAY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1524
Mailing Address - Country:US
Mailing Address - Phone:614-878-6413
Mailing Address - Fax:614-878-1159
Practice Address - Street 1:104 N MURRAY HILL ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1524
Practice Address - Country:US
Practice Address - Phone:614-878-6413
Practice Address - Fax:614-878-1159
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2012986Medicaid
OH2012986Medicaid
OHPE0819632Medicare PIN