Provider Demographics
NPI:1114193497
Name:COLLINGE, JANINE (MD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:COLLINGE
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 1:98 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1720
Mailing Address - Country:US
Mailing Address - Phone:860-453-0945
Mailing Address - Fax:
Practice Address - Street 1:98 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1720
Practice Address - Country:US
Practice Address - Phone:860-453-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29659207WX0110X, 207W00000X
CT62465207WX0110X
MI4301510807207W00000X
IN01070981A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200495460AMedicaid
OK200495460AMedicaid