Provider Demographics
NPI:1528237898
Name:COLLINS, ANGELA CARRI (MLT,ASCP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CARRI
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MLT,ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 CRIMSON CIR
Mailing Address - Street 2:RELIANCE ROAD SUITE
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-6611
Mailing Address - Country:US
Mailing Address - Phone:304-262-4757
Mailing Address - Fax:304-262-4759
Practice Address - Street 1:158 CRIMSON CIR
Practice Address - Street 2:RELIANCE ROAD SUITE
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6611
Practice Address - Country:US
Practice Address - Phone:304-262-4757
Practice Address - Fax:304-262-4759
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011417Medicaid