Provider Demographics
NPI:1710958004
Name:COLLINS, ROGER STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:STEWART
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:STEWART
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2395 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6689
Mailing Address - Country:US
Mailing Address - Phone:919-535-9211
Mailing Address - Fax:919-535-9215
Practice Address - Street 1:2395 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6689
Practice Address - Country:US
Practice Address - Phone:919-535-9211
Practice Address - Fax:919-535-9215
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00353208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI29034Medicare UPIN