Provider Demographics
NPI:1225355787
Name:COLTON, PAUL MARVIN (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MARVIN
Last Name:COLTON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 JEFFERSON DAVIS HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4565
Mailing Address - Country:US
Mailing Address - Phone:540-372-2028
Mailing Address - Fax:540-373-0945
Practice Address - Street 1:603 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4565
Practice Address - Country:US
Practice Address - Phone:540-372-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY504869163W00000X
NYF40131321363LP0808X
VA0024170972363LP0808X
VA0001233424163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse