MEDICARE: VICTORIA IRENE COLLAROS 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
1	207Q00000X	Family Medicine Physician	0101057897	VA
2	207Q00000X	Family Medicine Physician	35-126324	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1588628648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA IRENE COLLAROS MD

Provider Business Mailing Address
First Line	:	1 NEUMANN WAY
Second Line	:	BUILDING 750
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1915
Country	:	US
Telephone Number	:	513-853-8900
Fax Number	:	513-853-8998

Provider Business Practice Location Address
First Line	:	1 NEUMANN WAY
Second Line	:	BUILDING 750
City	:	CINCINNATI
State	:	OH
Zip	:	45215-1915
Country	:	US
Telephone Number	:	513-853-8900
Fax Number	:	513-853-8998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	02/23/2016

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