Provider Demographics
NPI:1457452120
Name:COLLINS, CHARLES M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4519
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-0519
Mailing Address - Country:US
Mailing Address - Phone:401-847-1383
Mailing Address - Fax:401-848-5809
Practice Address - Street 1:42 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6376
Practice Address - Country:US
Practice Address - Phone:401-847-1383
Practice Address - Fax:401-848-5809
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD09857207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RID73692Medicare UPIN
RI1890351Medicare PIN
RI4442470001Medicare NSC