Provider Demographics
NPI:1316972078
Name:COLLINS, BETH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 BOSTON POST RD
Mailing Address - Street 2:SUITE 16C
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1369
Mailing Address - Country:US
Mailing Address - Phone:203-689-5295
Mailing Address - Fax:203-689-5428
Practice Address - Street 1:2614 BOSTON POST RD
Practice Address - Street 2:SUITE 16C
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1369
Practice Address - Country:US
Practice Address - Phone:203-689-5295
Practice Address - Fax:203-689-5428
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058158208200000X
MS18970208600000X
CT047848208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52223095OtherBC/BS GEORGIA
GAP00644692Medicare PIN
CTD400013762Medicare PIN
GA511I020131Medicare PIN