Provider Demographics
NPI:1326145954
Name:COLIN, ELSIE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:MARIE
Last Name:COLIN
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:P.O BOX 64800
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896
Mailing Address - Country:US
Mailing Address - Phone:225-448-2087
Mailing Address - Fax:225-636-2648
Practice Address - Street 1:3968 NORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3826
Practice Address - Country:US
Practice Address - Phone:225-448-2087
Practice Address - Fax:225-636-2648
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178162208100000X
LA15662R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY0033T231Medicare ID - Type Unspecified
NYE84137Medicare UPIN
NY00246075Medicaid