Provider Demographics
NPI:1063431724
Name:COLLINS, MARY LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY LOUISE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:SUITE 505
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6831
Practice Address - Country:US
Practice Address - Phone:443-849-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD44743207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07840OtherGBMC AMERIGROUP
MD918786OtherGBMC MD EYE CARE
MD420626OtherGBMC MAMSI OPHTHAL
MD13770OtherGBMC HOPKINS PRODUCTS
MD233168OtherGBMC KAISER PERM
MD918786OtherGBMC BALT CITY VISION
MD1404697003OtherGBMC CIGNA
MD060771100Medicaid
MD0801150OtherUHC AMERICHOICE
MD520626OtherGBMC MAMSI PED OPTHAL
MDKJ54GB-53363202OtherGBMC CAREFIRST MD
MDS1410001OtherGBMC CAREFIRST REGIONAL
MD420626OtherGBMC MAMSI OPHTHAL
MD520626OtherGBMC MAMSI PED OPTHAL
MD13770OtherGBMC HOPKINS PRODUCTS
MD714L453DMedicare PIN