Provider Demographics
NPI:1538120035
Name:COLLINS, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 COTTMAN AVENUE
Mailing Address - Street 2:MEDICAL STAFF OFFICE/ENROLLMENT
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111
Mailing Address - Country:US
Mailing Address - Phone:215-728-6900
Mailing Address - Fax:606-432-5791
Practice Address - Street 1:333 COTTMAN AVENUE
Practice Address - Street 2:FOX CHASE CANCER CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-728-6900
Practice Address - Fax:606-432-5791
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33315208G00000X
PAMD446507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933582Medicaid
KY0708401Medicare ID - Type Unspecified
KY65933582Medicaid