Provider Demographics
NPI:1821317959
Name:FORD, COLLEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-887-3772
Mailing Address - Fax:617-887-3707
Practice Address - Street 1:151 EVERETT AVENUE
Practice Address - Street 2:CHELSEA HEALTHCARE CENTER
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1807
Practice Address - Country:US
Practice Address - Phone:617-887-3772
Practice Address - Fax:617-887-3707
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA244078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine