Provider Demographics
NPI:1518923481
Name:DEVINNEY, COLLEEN ANN (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:DEVINNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 FORT WASHINGTON AVE
Mailing Address - Street 2:STE E2
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034
Mailing Address - Country:US
Mailing Address - Phone:215-646-1686
Mailing Address - Fax:215-628-4956
Practice Address - Street 1:1244 FORT WASHINGTON AVE
Practice Address - Street 2:STE E2
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034
Practice Address - Country:US
Practice Address - Phone:215-646-1686
Practice Address - Fax:215-628-4956
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2018-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPA00S007670L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G06680Medicare UPIN
PA777915FXQMedicare ID - Type Unspecified