MEDICARE: DR. JOSEPH GEORGE COLONNA M.D.

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	208800000X	Urology Physician	D32730	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2406	OTHER	MD	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1801854179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH GEORGE COLONNA M.D.

Provider Business Mailing Address
First Line	:	11350 PEMBROOKE SQ
Second Line	:	SUITE 311
City	:	WALDORF
State	:	MD
Zip	:	20603-4809
Country	:	US
Telephone Number	:	301-645-7011
Fax Number	:	301-645-7964

Provider Business Practice Location Address
First Line	:	11350 PEMBROOKE SQ
Second Line	:	SUITE 311
City	:	WALDORF
State	:	MD
Zip	:	20603-4809
Country	:	US
Telephone Number	:	301-645-7011
Fax Number	:	301-645-7964

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/12/2010

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