Provider Demographics
NPI:1811995293
Name:AITKEN, COLLEEN A (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:A
Last Name:AITKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-383-1296
Practice Address - Street 1:301 HOWARD RD
Practice Address - Street 2:
Practice Address - City:WESTLEY
Practice Address - State:CA
Practice Address - Zip Code:95387
Practice Address - Country:US
Practice Address - Phone:209-894-3141
Practice Address - Fax:209-894-3082
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A682980OtherBLUE SHIELD OF CA PIN
CA102109OtherBOARD CERT #
CABG6588480OtherDEA CERT #
CABG6588480OtherDEA CERT #
CA00A682980Medicare PIN