Provider Demographics
NPI:1689769523
Name:CULLEN, COLLIN DEMPSEY (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:DEMPSEY
Last Name:CULLEN
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 1:5410 CONNECTICUT AVE NW STE 117
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2831
Mailing Address - Country:US
Mailing Address - Phone:202-966-2828
Mailing Address - Fax:202-966-0108
Practice Address - Street 1:5410 CONNECTICUT AVE NW STE 117
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2831
Practice Address - Country:US
Practice Address - Phone:202-966-2828
Practice Address - Fax:202-966-0108
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD0052247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG51746Medicare UPIN