Provider Demographics
NPI:1720014251
Name:BRENT, COLLEEN HEATHER (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:HEATHER
Last Name:BRENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:HEATHER
Other - Last Name:RUMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1012 MILLERS SPRING RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17406-8613
Mailing Address - Country:US
Mailing Address - Phone:717-252-2354
Mailing Address - Fax:
Practice Address - Street 1:1012 MILLERS SPRING RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8613
Practice Address - Country:US
Practice Address - Phone:717-252-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420297207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1544543OtherGATEWAY-YH
PA101071369Medicaid
PA1614661OtherHIGHMARK BLUE SHIELD-YH
PA1614661OtherHIGHMARK BLUE SHIELD-YH
PA101071369Medicaid