Provider Demographics
NPI:1518946771
Name:COLLINS, PHILLIP B (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:B
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2694
Mailing Address - Country:US
Mailing Address - Phone:603-448-3121
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:127 MASCOMA ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2661
Practice Address - Country:US
Practice Address - Phone:603-448-7459
Practice Address - Fax:603-448-7469
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH104962083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00039897OtherBLUE CROSS BLUE SHIELD VT
NHCOLL251643OtherANTHEM NH
VT1008021Medicaid
NH1518946771OtherMVP
NH30200260Medicaid