Provider Demographics
NPI:1154301950
Name:MCCAUL, COLIN P (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:P
Last Name:MCCAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SCIENCE PARK RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2293
Mailing Address - Country:US
Mailing Address - Phone:814-272-5805
Mailing Address - Fax:814-272-0110
Practice Address - Street 1:301 SCIENCE PARK RD
Practice Address - Street 2:SUITE 207
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2293
Practice Address - Country:US
Practice Address - Phone:814-272-5805
Practice Address - Fax:814-272-0110
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428049208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016152280001Medicaid
PA097686OtherMEDICARE LEGACY GROUP#
PACI7521OtherRAILROAD MEDICARE GRP#
PA50062055OtherCAPITAL BCBS#
PA1873055OtherHIGHMARK#
PAP00409316OtherRAILROAD MEDICARE INDIV#
PA098437UZTMedicare PIN
PA50062055OtherCAPITAL BCBS#