Provider Demographics
NPI:1336123330
Name:COLLINS, COLLEEN MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MARIA
Last Name:COLLINS
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:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01903-0626
Mailing Address - Country:US
Mailing Address - Phone:781-581-3900
Mailing Address - Fax:781-598-1050
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-581-3900
Practice Address - Fax:781-598-1050
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA071453OtherTUFTS HEALTH PLAN
MA3112888Medicaid
MAJ14192OtherBCBS MA
MA3112888Medicaid
MA071453OtherTUFTS HEALTH PLAN