Provider Demographics
NPI:1396736260
Name:COLLINS, STEVEN JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5720 WILLIAMSON RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-1225
Mailing Address - Country:US
Mailing Address - Phone:540-491-9893
Mailing Address - Fax:540-301-3522
Practice Address - Street 1:5720 WILLIAMSON RD
Practice Address - Street 2:SUITE 109
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1225
Practice Address - Country:US
Practice Address - Phone:540-491-9893
Practice Address - Fax:540-301-3522
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2011-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H47008Medicare UPIN