Provider Demographics
NPI:1356306948
Name:COLLINS, MARCIA L (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
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 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:STE 4600
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1273
Mailing Address - Country:US
Mailing Address - Phone:937-296-0167
Mailing Address - Fax:937-297-2330
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:STE 4600
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1273
Practice Address - Country:US
Practice Address - Phone:937-296-0167
Practice Address - Fax:937-297-2330
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033205207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2269549Medicaid
000000009464OtherANTHEM PIN
C00807382Medicare ID - Type Unspecified
000000009464OtherANTHEM PIN