Provider Demographics
NPI:1790888584
Name:COLLINS, SIOBHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIOBHAN
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 FARMINGTON AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1943
Mailing Address - Country:US
Mailing Address - Phone:860-676-1900
Mailing Address - Fax:860-409-0602
Practice Address - Street 1:499 FARMINGTON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1943
Practice Address - Country:US
Practice Address - Phone:860-676-1900
Practice Address - Fax:860-409-0602
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040694207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1047826OtherCIGNA
CT7434428OtherAETNA
CTP4433843OtherOXFORD
CT040694OtherCONNECTICARE
CT2458330OtherUNITED HEALTHCARE
CT010040694CT05OtherANTHEM BCBS
CT010040694CT05OtherANTHEM BCBS
CT7434428OtherAETNA