Provider Demographics
NPI:1649268293
Name:COLLINS, J. JOHN (MD)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:JOHN
Last Name:COLLINS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1245 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE #301
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6258
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039680L207L00000X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011694160003Medicaid
PA0031980000OtherINDEP BLUE CROSS
PW1010377OtherAMERIHEALTH MERCY
PA0416119OtherKHP CENTRAL
PA000000093574OtherTHREE RIVERS
PA1010377OtherKEYSTONE MERCY
PA416119OtherHIGHMARK
PA01169416OtherGATEWAY
PA1010377OtherKEYSTONE MERCY
PA000000093574OtherTHREE RIVERS
PA050031744Medicare PIN