Provider Demographics
NPI:1396967709
Name:COLL, JAIME (MD,)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:COLL
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:COLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3 BRENDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1603
Mailing Address - Country:US
Mailing Address - Phone:856-874-0202
Mailing Address - Fax:856-874-0220
Practice Address - Street 1:3 BRENDENWOOD DR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1603
Practice Address - Country:US
Practice Address - Phone:856-874-0202
Practice Address - Fax:856-874-0220
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02255300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098793Medicare ID - Type Unspecified
NJD06184Medicare UPIN