Basic Information
| Provider Information | |||||||||
| NPI: | 1528081197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 BRANTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219218344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103929192 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 W HIGH ST | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109969490 | ||||||||
| FaxNumber: | 4109969493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | C0002038 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 162975 | 01 | COVENTRY INS ID PROV # | OTHER |