Provider Demographics
NPI:1588628648
Name:COLLAROS, VICTORIA IRENE (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:IRENE
Last Name:COLLAROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEUMANN WAY
Mailing Address - Street 2:BUILDING 750
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1915
Mailing Address - Country:US
Mailing Address - Phone:513-853-8900
Mailing Address - Fax:513-853-8998
Practice Address - Street 1:1 NEUMANN WAY
Practice Address - Street 2:BUILDING 750
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1915
Practice Address - Country:US
Practice Address - Phone:513-853-8900
Practice Address - Fax:513-853-8998
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057897207Q00000X
OH35-126324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0134242Medicaid
VA1588628648Medicaid
OH0134242Medicaid
VA1588628648Medicaid
OHH373510Medicare PIN
VAP00191966Medicare PIN