Provider Demographics
NPI:1427057892
Name:COLO-RECTAL ASSOCIATES
Entity type:Organization
Organization Name:COLO-RECTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-373-8040
Mailing Address - Street 1:2566 HAYMAKER RD
Mailing Address - Street 2:SUITE206
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3517
Mailing Address - Country:US
Mailing Address - Phone:412-373-8040
Mailing Address - Fax:412-856-5471
Practice Address - Street 1:2566 HAYMAKER RD
Practice Address - Street 2:SUITE206
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3517
Practice Address - Country:US
Practice Address - Phone:412-373-8040
Practice Address - Fax:412-856-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA80547OtherAETNA US HEALTHCARE
PA003918Medicare ID - Type Unspecified