Provider Demographics
NPI:1750529483
Name:MAXCY, COLLEEN S (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:S
Last Name:MAXCY
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 1:300 STATE ST E STE 222
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3711
Mailing Address - Country:US
Mailing Address - Phone:813-855-8400
Mailing Address - Fax:813-855-9200
Practice Address - Street 1:300 STATE ST E STE 222
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3711
Practice Address - Country:US
Practice Address - Phone:813-855-8400
Practice Address - Fax:813-855-9200
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107168208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDR453YMedicare PIN