Provider Demographics
NPI:1316336449
Name:AFRIYIE, COLLINA (PAC)
Entity type:Individual
Prefix:
First Name:COLLINA
Middle Name:
Last Name:AFRIYIE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 VOLUNTEER DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-9706
Mailing Address - Country:US
Mailing Address - Phone:571-385-9648
Mailing Address - Fax:
Practice Address - Street 1:196 THOMAS JOHNSON DR STE 120
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4521
Practice Address - Country:US
Practice Address - Phone:240-566-3130
Practice Address - Fax:240-566-3131
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05636363AM0700X
MDC0005636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521041100Medicaid