Provider Demographics
NPI:1750495750
Name:MCBRIDE, COLIN GRENIER
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:GRENIER
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 BRIDGE ST
Mailing Address - Street 2:APARTMENT 1211
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-7416
Mailing Address - Country:US
Mailing Address - Phone:508-254-8974
Mailing Address - Fax:
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:ORTHOPAEDIC SURGERY 7TH FLOOR
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103790363AS0400X
MAPA2114363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical