Provider Demographics
NPI:1619002649
Name:COLLEY, DORISCINE LENAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DORISCINE
Middle Name:LENAY
Last Name:COLLEY
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:PO BOX 6553
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-6553
Mailing Address - Country:US
Mailing Address - Phone:410-685-1188
Mailing Address - Fax:410-685-1889
Practice Address - Street 1:12150 ANNAPOLIS RD
Practice Address - Street 2:STE 211
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:410-685-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46464208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00232Medicare UPIN