Provider Demographics
NPI:1205923737
Name:COLLINS, ANDREW RICHARD (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:RICHARD
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:17021 OLD ORCHARD RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4832
Mailing Address - Country:US
Mailing Address - Phone:302-644-8008
Mailing Address - Fax:302-644-6883
Practice Address - Street 1:17021 OLD ORCHARD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4832
Practice Address - Country:US
Practice Address - Phone:302-644-8008
Practice Address - Fax:302-644-6883
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000147213E00000X
PASC004403L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122055OtherMAMSI
50184OtherMID ATLANTIC
2245531000OtherAMERIHEALTH HMO
211052OtherCOVENTRY
P00148040OtherRR MEDICARE
DE1000027199Medicaid
1319436OtherBCBS
1565980OtherAMERIHEALTH PPO
U82739Medicare UPIN
490760Medicare ID - Type Unspecified