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NPI Code Detail

MEDICARE: DR. COLLINS F KELLOGG JR. MD

MEDICARE: DR. COLLINS F KELLOGG JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician169537NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22503552OTHERNYGHI

General Provider Information

NPI Number : 1225031255
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COLLINS F KELLOGG JR. MD
Provider Business Mailing Address
First Line : 53-59 PUBLIC SQ
Second Line : STE 301
City : WATERTOWN
State : NY
Zip : 13601-2674
Country : US
Telephone Number : 315-782-2141
Fax Number : 315-782-5123
Provider Business Practice Location Address
First Line : 53-59 PUBLIC SQ
Second Line : STE 301
City : WATERTOWN
State : NY
Zip : 13601-2674
Country : US
Telephone Number : 315-782-2141
Fax Number : 315-782-5123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 10/25/2007

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