Provider Demographics
NPI:1518256452
Name:COLLINS MEDICAL ASSOCIATES 2 PC
Entity Type:Organization
Organization Name:COLLINS MEDICAL ASSOCIATES 2 PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO- PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BECAHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-714-5415
Mailing Address - Street 1:673 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3033
Mailing Address - Country:US
Mailing Address - Phone:860-242-3000
Mailing Address - Fax:
Practice Address - Street 1:1000 ASYLUM AVE STE 3218
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1702
Practice Address - Country:US
Practice Address - Phone:860-714-5415
Practice Address - Fax:860-714-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
CT018911207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001319880Medicaid