Basic Information
| Provider Information | |||||||||
| NPI: | 1568796662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLAZO | ||||||||
| FirstName: | ANELA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 OLD WESTMINSTER PIKE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211576267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108716864 | ||||||||
| FaxNumber: | 4108716226 | ||||||||
| Practice Location | |||||||||
| Address1: | 844 WASHINGTON RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211576664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108710088 | ||||||||
| FaxNumber: | 4108710083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2009 | ||||||||
| LastUpdateDate: | 10/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | C0003833 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.