Provider Demographics
NPI:1013904838
Name:COLLINS, RONALD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:COLLINS
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 1:1711 SAINT JULIAN PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2409
Mailing Address - Country:US
Mailing Address - Phone:803-779-0911
Mailing Address - Fax:803-256-2480
Practice Address - Street 1:1711 SAINT JULIAN PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2409
Practice Address - Country:US
Practice Address - Phone:803-779-0911
Practice Address - Fax:803-256-2480
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8598207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC085981Medicaid
SC085981Medicaid
2922Medicare ID - Type Unspecified