Provider Demographics
NPI:1245953215
Name:HEALTHCARE COLLEAGUES PA
Entity type:Organization
Organization Name:HEALTHCARE COLLEAGUES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLERIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-260-2606
Mailing Address - Street 1:411 MAITLAND AVE STE 1001
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5448
Mailing Address - Country:US
Mailing Address - Phone:407-260-2606
Mailing Address - Fax:
Practice Address - Street 1:411 MAITLAND AVE STE 1001
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5448
Practice Address - Country:US
Practice Address - Phone:407-260-2606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty