Provider Demographics
NPI:1659356533
Name:COLBY, JAY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MICHAEL
Last Name:COLBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-0609
Mailing Address - Country:US
Mailing Address - Phone:860-415-9248
Mailing Address - Fax:860-415-9237
Practice Address - Street 1:25 WELLS STREET
Practice Address - Street 2:THE WESTERLY HOSPITAL
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2460
Practice Address - Country:US
Practice Address - Phone:860-415-9248
Practice Address - Fax:860-415-9237
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD111742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJC21238Medicaid
RIJC21238Medicaid