Provider Demographics
NPI:1952869984
Name:COLLIN D. CULLEN, M.D., LLC
Entity Type:Organization
Organization Name:COLLIN D. CULLEN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-502-8702
Mailing Address - Street 1:5410 CONNECTICUT AVE NW STE 117
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2831
Mailing Address - Country:US
Mailing Address - Phone:301-502-8702
Mailing Address - Fax:
Practice Address - Street 1:5410 CONNECTICUT AVE NW STE 117
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2831
Practice Address - Country:US
Practice Address - Phone:301-502-8702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care