Provider Demographics
NPI:1881091726
Name:COLGATE UNIVERSITY
Entity type:Organization
Organization Name:COLGATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT HEALTH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-228-7750
Mailing Address - Street 1:13 OAK DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1338
Mailing Address - Country:US
Mailing Address - Phone:315-228-7750
Mailing Address - Fax:315-228-6823
Practice Address - Street 1:140 BROAD ST.
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1338
Practice Address - Country:US
Practice Address - Phone:315-228-7750
Practice Address - Fax:315-228-6823
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLGATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-20
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118327-1261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health