Provider Demographics
NPI:1992072987
Name:COLON, EDDIE ANTHONY (CCT, RCP)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:ANTHONY
Last Name:COLON
Suffix:
Gender:M
Credentials:CCT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 TIDE MILL LN
Mailing Address - Street 2:3A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2764
Mailing Address - Country:US
Mailing Address - Phone:917-755-3696
Mailing Address - Fax:757-439-1428
Practice Address - Street 1:2217 W ARNOLD AVE
Practice Address - Street 2:514TH ASTS: UNITED STATES AIR FORCE RESERVES
Practice Address - City:MCGUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641
Practice Address - Country:US
Practice Address - Phone:609-754-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0117006807227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered