Provider Demographics
NPI:1629637152
Name:PAPENFUSS, COLLIN MICHAEL (NREMT)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:MICHAEL
Last Name:PAPENFUSS
Suffix:
Gender:M
Credentials:NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11834 CHASE WELLESLEY DR APT 533
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7756
Mailing Address - Country:US
Mailing Address - Phone:804-878-8079
Mailing Address - Fax:
Practice Address - Street 1:5200 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-2820
Practice Address - Country:US
Practice Address - Phone:410-887-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-09
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB103017909146N00000X
MD1851966146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic