Provider Demographics
NPI:1023040326
Name:COLON, MICHAEL T (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:COLON
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 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-489-3292
Mailing Address - Fax:518-453-6286
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-489-3292
Practice Address - Fax:518-453-6286
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044231208000000X
NY25675412080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT370001774Medicare Oscar/Certification