Provider Demographics
NPI:1649237199
Name:COLBERT, RAYMOND ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ALAN
Last Name:COLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RIDDELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2025
Mailing Address - Country:US
Mailing Address - Phone:413-774-5505
Mailing Address - Fax:413-774-5860
Practice Address - Street 1:33 RIDDELL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2025
Practice Address - Country:US
Practice Address - Phone:413-774-5505
Practice Address - Fax:413-774-5860
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45921207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0105864Medicaid
B74004Medicare UPIN
MA0105864Medicaid