Provider Demographics
NPI:1265533293
Name:COLLMAN, REBECCA JANE (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:COLLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:COLLMAN
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:164 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-7168
Mailing Address - Country:US
Mailing Address - Phone:802-878-7844
Mailing Address - Fax:802-872-9667
Practice Address - Street 1:164 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-7168
Practice Address - Country:US
Practice Address - Phone:802-878-7844
Practice Address - Fax:802-872-9667
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT420007780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT415510OtherCIGNA
VT9919OtherBLUECROSS/BLUESHIELD
VT1002884Medicaid
VT26V031OtherMVP HEALTHCARE
VT415510OtherCIGNA