Provider Demographics
NPI:1952391443
Name:COLLIER, ANDREW J JR (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:COLLIER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410-14 S BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145
Mailing Address - Country:US
Mailing Address - Phone:215-334-3350
Mailing Address - Fax:215-336-6980
Practice Address - Street 1:2410-14 S BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145
Practice Address - Country:US
Practice Address - Phone:215-334-3350
Practice Address - Fax:215-336-6980
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025722E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010115550001Medicaid
0052402000OtherKEYSTONE EAST HMO
0032976OtherAETNA HMO
PA0010115550001Medicaid
B39389Medicare UPIN