Provider Demographics
NPI:1598748634
Name:COLLIER, ANNAMARIE REDDIN (MD)
Entity Type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:REDDIN
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNAMARIE
Other - Middle Name:
Other - Last Name:REDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 SUMMIT CROSSING PL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2176
Mailing Address - Country:US
Mailing Address - Phone:704-867-8021
Mailing Address - Fax:704-864-4606
Practice Address - Street 1:620 SUMMIT CROSSING PL
Practice Address - Street 2:SUITE 106
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2176
Practice Address - Country:US
Practice Address - Phone:704-867-8021
Practice Address - Fax:704-864-4606
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC356162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300068234OtherRAILROAD MEDICARE
23769OtherBLUE CROSS BLUE SHIELD
SCN35616Medicaid
2353036OtherAETNA HMO
4620619OtherAETNA PPO
73399OtherMEDCOST
1642993OtherUNITED HEALTHCARE
6676OtherPARTNERS
NC8923769Medicaid
2353036OtherAETNA HMO
2176093Medicare ID - Type Unspecified