Provider Demographics
NPI:1962454884
Name:COLLMAN, MITCHELL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:SCOTT
Last Name:COLLMAN
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 1:2615 LAKE DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6693
Mailing Address - Country:US
Mailing Address - Phone:919-960-7100
Mailing Address - Fax:
Practice Address - Street 1:2615 LAKE DR
Practice Address - Street 2:SUITE 301
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6693
Practice Address - Country:US
Practice Address - Phone:919-960-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26646207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC83311Medicare UPIN