Provider Demographics
NPI:1841201993
Name:BROWNELL-KRUPAT, COLLEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:A
Last Name:BROWNELL-KRUPAT
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 1:486 BOSTON POST ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1529
Mailing Address - Country:US
Mailing Address - Phone:781-899-4456
Mailing Address - Fax:781-647-9578
Practice Address - Street 1:486 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1529
Practice Address - Country:US
Practice Address - Phone:781-899-4456
Practice Address - Fax:781-647-9578
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86520208000000X
MA231898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A865200Medicaid
CA00A865200Medicaid