Provider Demographics
NPI:1790848729
Name:COLBERT, DAVID ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:COLBERT
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 1:130 W 17TH ST
Mailing Address - Street 2:7N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5415
Mailing Address - Country:US
Mailing Address - Phone:646-486-7280
Mailing Address - Fax:
Practice Address - Street 1:119 5TH AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1007
Practice Address - Country:US
Practice Address - Phone:212-533-8888
Practice Address - Fax:212-673-5185
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175534174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP369521OtherOXFORD HEALTH PLANS
NYHEALTHNETOtherNZ8686
NY67K781OtherBLUE CROSS BLUE SHIELD
NYHEALTHNETOtherNZ8686
NYF32073Medicare UPIN
NYP369521OtherOXFORD HEALTH PLANS