Provider Demographics
NPI:1326134784
Name:PARKER, COLLEEN M (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:PARKER
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 1:920 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4105
Mailing Address - Country:US
Mailing Address - Phone:864-233-6338
Mailing Address - Fax:864-235-1982
Practice Address - Street 1:920 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4105
Practice Address - Country:US
Practice Address - Phone:864-233-6338
Practice Address - Fax:864-235-1982
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21400207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC214002Medicaid
SC214002Medicaid