Provider Demographics
NPI:1215917638
Name:MARIAS, COLEEN K (MD)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:K
Last Name:MARIAS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 N. NORTERRA PARKWAY, BLDG B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-277-1000
Mailing Address - Fax:602-906-2789
Practice Address - Street 1:8901 E RAINTREE DR STE 150
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7110
Practice Address - Country:US
Practice Address - Phone:480-733-7600
Practice Address - Fax:602-805-2816
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28266208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ503864Medicaid
AZ503864Medicaid
AZ84600Medicare ID - Type Unspecified