Provider Demographics
NPI:1508843749
Name:COLLINS, INGEBORG (MD)
Entity Type:Individual
Prefix:
First Name:INGEBORG
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 W GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3825
Practice Address - Country:US
Practice Address - Phone:980-487-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
82339OtherMEDCOST
1164T02662OtherBCBS
NC891164TMedicaid
2110965OtherAETNA US HEALTH
NC1508843749Medicaid
560943383HOtherCIGNA
741491OtherUHC
291772OtherMAMSI
5392684OtherAETNA
SCN00227Medicaid
SCN00227Medicaid
NCNCE239AMedicare PIN
NC1508843749Medicaid
NC2252278AMedicare PIN