Provider Demographics
NPI:1760661672
Name:OHM, COLLEEN LOUISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:LOUISE
Last Name:OHM
Suffix:
Gender:F
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 1:12830 HOLIDAY LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1140
Mailing Address - Country:US
Mailing Address - Phone:410-937-6735
Mailing Address - Fax:
Practice Address - Street 1:12830 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1140
Practice Address - Country:US
Practice Address - Phone:410-937-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant