Provider Demographics
NPI:1518959519
Name:MOORHEAD, COLIN STUART (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:STUART
Last Name:MOORHEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 WHITE POND DR
Mailing Address - Street 2:#100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1185
Mailing Address - Country:US
Mailing Address - Phone:330-869-8530
Mailing Address - Fax:330-869-8539
Practice Address - Street 1:470 WHITE POND DR
Practice Address - Street 2:#100
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1185
Practice Address - Country:US
Practice Address - Phone:330-869-8530
Practice Address - Fax:330-869-8539
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-077486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2269129Medicaid
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OHH072000Medicare PIN
OHH45032Medicare UPIN