Provider Demographics
NPI:1932357019
Name:COLLURA, NATASHA A (PA)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:A
Last Name:COLLURA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:NATASHA
Other - Middle Name:A
Other - Last Name:ATALLAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:7 GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5000
Mailing Address - Country:US
Mailing Address - Phone:203-798-8422
Mailing Address - Fax:
Practice Address - Street 1:7 GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5000
Practice Address - Country:US
Practice Address - Phone:203-798-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000139363AM0700X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical