Provider Demographics
NPI:1346807450
Name:COLLINS, MICAELA LANGILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICAELA
Middle Name:LANGILLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1015 WALNUT ST STE 620
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5005
Mailing Address - Country:US
Mailing Address - Phone:215-955-6864
Mailing Address - Fax:215-955-2878
Practice Address - Street 1:1015 WALNUT ST STE 620
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5005
Practice Address - Country:US
Practice Address - Phone:215-955-6864
Practice Address - Fax:215-955-2878
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT217857208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery