Provider Demographics
NPI:1558348656
Name:COLLIER, H. EDWARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:H.
Middle Name:EDWARD
Last Name:COLLIER
Suffix:III
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 1:775 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7497
Mailing Address - Country:US
Mailing Address - Phone:717-274-5500
Mailing Address - Fax:717-202-0130
Practice Address - Street 1:775 NORMAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7497
Practice Address - Country:US
Practice Address - Phone:717-274-5500
Practice Address - Fax:717-202-0130
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042678E207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017696060004Medicaid
PAPO1677368OtherRAILROAD MEDICARE
PAE81810Medicare UPIN
PAPO1677368OtherRAILROAD MEDICARE
PA030839FLTMedicare PIN