Provider Demographics
NPI:1851362180
Name:COLLINS, KEVIN LAMONT (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LAMONT
Last Name:COLLINS
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Gender:M
Credentials:DO
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Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:19 WOODLAND STREET
Practice Address - Street 2:SUITE 42
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-249-9336
Practice Address - Fax:860-247-6897
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-03-17
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Provider Licenses
StateLicense IDTaxonomies
CT041836207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H80046Medicare UPIN