Provider Demographics
NPI:1699784561
Name:COLLINS, A. THOMAS (MD)
Entity type:Individual
Prefix:
First Name:A.
Middle Name:THOMAS
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 1:1600 116TH AVE NE
Mailing Address - Street 2:SUITE #302
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3014
Mailing Address - Country:US
Mailing Address - Phone:425-455-5440
Mailing Address - Fax:425-455-1431
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:SUITE #302
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3014
Practice Address - Country:US
Practice Address - Phone:425-455-5440
Practice Address - Fax:425-455-1431
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA146952084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1471200Medicaid
WAA04298Medicare UPIN
WA1471200Medicaid