Provider Demographics
NPI:1063654135
Name:COLGAN, DEIRDRE (MD)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:COLGAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-723-7575
Mailing Address - Fax:585-368-4890
Practice Address - Street 1:1200 DRIVING PARK AVENUE
Practice Address - Street 2:PO BOX 111
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1090
Practice Address - Country:US
Practice Address - Phone:315-359-2557
Practice Address - Fax:315-359-2248
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2022-01-27
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Provider Licenses
StateLicense IDTaxonomies
NY269623207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04464600Medicaid