Provider Demographics
NPI:1649222126
Name:COLLINS, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1586
Mailing Address - Country:US
Mailing Address - Phone:207-664-5642
Mailing Address - Fax:207-664-5664
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1586
Practice Address - Country:US
Practice Address - Phone:207-664-5642
Practice Address - Fax:207-664-5664
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013419208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME218350099Medicaid
ME218350099Medicaid
MEMM441402Medicare PIN
F09700Medicare UPIN
MM4414Medicare ID - Type Unspecified