Provider Demographics
NPI:1316996648
Name:COLLIER, ALDON ROCKWELL (MD)
Entity type:Individual
Prefix:
First Name:ALDON
Middle Name:ROCKWELL
Last Name:COLLIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-461-6342
Mailing Address - Fax:757-963-6158
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-461-6342
Practice Address - Fax:757-963-6158
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052557208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006729193Medicaid
541778786OtherUNITED HEALTH CARE
13539OtherOPTIMA HEALTH PLAN
233030OtherMAMSI HEALTH PLAN
5417787860404EOtherCIGNA HEALTHCARE
250428OtherANTHEM BCBS
4653015OtherAETNA
541778786OtherUNITED HEALTH CARE