Provider Demographics
NPI:1265503551
Name:COLLET, ANDREA K (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:K
Last Name:COLLET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:K
Other - Last Name:FRUEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2582
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-2582
Mailing Address - Country:US
Mailing Address - Phone:740-562-6868
Mailing Address - Fax:740-205-8661
Practice Address - Street 1:305 SUNRISE CENTER DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4663
Practice Address - Country:US
Practice Address - Phone:740-816-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0826352080S0010X
OH35082635208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430284Medicaid
OHFR4116461Medicare PIN