Provider Demographics
NPI:1457442071
Name:COLLINS, T EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:T
Middle Name:EDWARD
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 TUTTLE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-4117
Mailing Address - Country:US
Mailing Address - Phone:207-712-4759
Mailing Address - Fax:
Practice Address - Street 1:267 TUTTLE RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021-4117
Practice Address - Country:US
Practice Address - Phone:207-712-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME10162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME332890000Medicaid
ME060963OtherANTHEM BLUE CROSS
ME4240865OtherAETNA
MEP00096706OtherRAILROAD MEDICARE
ME015564Medicare ID - Type Unspecified
ME332890000Medicaid