Provider Demographics
NPI:1639279797
Name:COLLINS, KATHRYN MARIN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MARIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE
Mailing Address - Street 2:#C-50
Mailing Address - City:KRIKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-899-4100
Mailing Address - Fax:425-899-4243
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:#C-50
Practice Address - City:KRIKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-4100
Practice Address - Fax:425-899-4243
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018326208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1678408Medicaid
000109277Medicare ID - Type Unspecified
A04300Medicare UPIN