Provider Demographics
NPI:1851402572
Name:COLLINS, WILLIAM T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4037 TAYLOR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5535
Mailing Address - Country:US
Mailing Address - Phone:757-483-1403
Mailing Address - Fax:757-483-3757
Practice Address - Street 1:4037 TAYLOR RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5535
Practice Address - Country:US
Practice Address - Phone:757-483-1403
Practice Address - Fax:757-483-3757
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-05-17
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Provider Licenses
StateLicense IDTaxonomies
UT4834367-8905208800000X
VA0101034439208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107009004101OtherSELECT HEALTH PLANS
UT340020002OtherRAILROAD MEDICARE
UT19-00118OtherUNITED HEALTHCARE
UT48343671200001OtherREGENCE BC/BS
UTQM0000054900OtherALTIUS HEALTH PLANS
UT694887OtherDESERET MUTUAL HEALTHCARE
UT870673378COLOtherEDUCATORS CARE
UT694887OtherDESERET MUTUAL HEALTHCARE
UT005708403Medicare ID - Type Unspecified
VAVV8567AMedicare PIN