Provider Demographics
NPI:1346304888
Name:COLBY, CRYSTAL M (PA-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:COLBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4101
Mailing Address - Country:US
Mailing Address - Phone:603-444-7070
Mailing Address - Fax:603-444-4075
Practice Address - Street 1:220 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4101
Practice Address - Country:US
Practice Address - Phone:603-444-7070
Practice Address - Fax:603-444-4075
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0611363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000321Medicaid
NHRE5088OtherMEDICARE B GROUP
NH30334835Medicaid
NHAP2829Medicare PIN
VT9000321Medicaid