Provider Demographics
NPI:1922144138
Name:COLLACO, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:COLLACO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N WOLFE ST
Mailing Address - Street 2:JOHNS HOPKINS HOSPITAL - PEDIATRIC PULMONARY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-2035
Mailing Address - Fax:410-955-0130
Practice Address - Street 1:200 N WOLFE ST
Practice Address - Street 2:JOHNS HOPKINS PEDIATRIC PULMONARY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0011
Practice Address - Country:US
Practice Address - Phone:410-955-2035
Practice Address - Fax:410-955-1030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00600762080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402376500Medicaid
466ML208Medicare ID - Type Unspecified
MD402376500Medicaid