Provider Demographics
NPI:1790105641
Name:WRIGHT, COLIN MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:MICHAEL
Last Name:WRIGHT
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 1:2211 GENESEE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5955
Mailing Address - Country:US
Mailing Address - Phone:315-733-7598
Mailing Address - Fax:
Practice Address - Street 1:2211 GENESEE ST STE 200
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5955
Practice Address - Country:US
Practice Address - Phone:315-733-7598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY295524-01207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program