Provider Demographics
NPI:1972908200
Name:COLLINS, ANITA KELLY (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:KELLY
Last Name:COLLINS
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 1:7724 BOGEY PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7416
Mailing Address - Country:US
Mailing Address - Phone:804-201-7098
Mailing Address - Fax:
Practice Address - Street 1:16492 MLC LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:VA
Practice Address - Zip Code:23146-1857
Practice Address - Country:US
Practice Address - Phone:804-620-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257206207Q00000X
TXH2503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine