Basic Information
| Provider Information | |||||||||
| NPI: | 1992969117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'DEA | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | MAGNUSON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1614 MOUNT VERNON ST | ||||||||
| Address2: | APT 2 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191303340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122190066 | ||||||||
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| Practice Location | |||||||||
| Address1: | BROAD AND VINE STREETS | ||||||||
| Address2: | MAIL STOP 623 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157622618 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2008 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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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 | 207P00000X | MT193425 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.