Provider Demographics
NPI:1528081197
Name:COLLINS, RICHARD SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SCOTT
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BRANTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-8344
Mailing Address - Country:US
Mailing Address - Phone:410-392-9192
Mailing Address - Fax:
Practice Address - Street 1:111 W HIGH ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5529
Practice Address - Country:US
Practice Address - Phone:410-996-9490
Practice Address - Fax:410-996-9493
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002038363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
162975OtherCOVENTRY INS ID PROV #
MDS93135Medicare UPIN
162975OtherCOVENTRY INS ID PROV #