Basic Information
| Provider Information | |||||||||
| NPI: | 1699769554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEIN | ||||||||
| FirstName: | COLLINS | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1558 | ||||||||
| Address2: | |||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016389670 | ||||||||
| FaxNumber: | 3016387558 | ||||||||
| Practice Location | |||||||||
| Address1: | 3460 OLD WASHINGTON RD | ||||||||
| Address2: | SUITE 203A | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206023240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019348811 | ||||||||
| FaxNumber: | 3019349321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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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 | 207R00000X | D0046979 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | F2470001 | 01 | DC | BLUE CROSS | OTHER | 293041 | 01 | MD | MAMSI, ALLIANCE | OTHER | 431203100 | 05 | MD | MEDICAID | KAF9SO | 01 | MD | BLUE CROSS | OTHER | 110237779 | 01 | MD | RAILROAD MEDICARE | OTHER |