Basic Information
| Provider Information | |||||||||
| NPI: | 1811405830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLLINS MEDICAL CONSULTING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 153 MAIN ST STE 119 | ||||||||
| Address2: | |||||||||
| City: | NORTH READING | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018643101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179222920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021091402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178764344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2018 | ||||||||
| LastUpdateDate: | 07/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | COREY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6179222920 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 07/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 220653 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.