Provider Demographics
NPI:1679235550
Name:LABUDA, COLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:LABUDA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23111 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2370
Mailing Address - Country:US
Mailing Address - Phone:248-275-3931
Mailing Address - Fax:
Practice Address - Street 1:11890 HEALING WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7917
Practice Address - Country:US
Practice Address - Phone:240-637-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant