Provider Demographics
NPI:1306830161
Name:COLACCHIO, DONALD A (MD)
Entity Type:Individual
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First Name:DONALD
Middle Name:A
Last Name:COLACCHIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1138
Practice Address - Country:US
Practice Address - Phone:508-273-4900
Practice Address - Fax:508-273-4901
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-04-21
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Provider Licenses
StateLicense IDTaxonomies
MA238471208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084413AMedicaid
MA001063501Medicare PIN
HX1322Medicare PIN