Provider Demographics
NPI:1568568780
Name:COLLINS, KEITH G (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:G
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2868
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0259
Mailing Address - Country:US
Mailing Address - Phone:518-562-7900
Mailing Address - Fax:518-562-7933
Practice Address - Street 1:159 MARGARET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1893
Practice Address - Country:US
Practice Address - Phone:518-314-3939
Practice Address - Fax:518-314-3940
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY192993207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01464494Medicaid
NY01464494Medicaid
NYJ400010967Medicare PIN