Provider Demographics
NPI:1497759310
Name:OLSON, COLLEEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:J
Last Name:OLSON
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 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-872-7700
Mailing Address - Fax:419-874-0196
Practice Address - Street 1:1601 BRIGHAM DR STE 200
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7117
Practice Address - Country:US
Practice Address - Phone:419-872-7700
Practice Address - Fax:419-874-0196
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35078056208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000141664OtherBLUE CROSS BLUE SHIELD PI
OH2208444Medicaid