Provider Demographics
NPI:1225357064
Name:FLANNERY, COLIN P (DPM)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:P
Last Name:FLANNERY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3037
Mailing Address - Country:US
Mailing Address - Phone:610-565-3668
Mailing Address - Fax:610-565-9722
Practice Address - Street 1:101 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3037
Practice Address - Country:US
Practice Address - Phone:610-565-3668
Practice Address - Fax:610-565-9722
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006446213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery