Healthcare Provider Details

I. General information

NPI: 1316972078
Provider Name (Legal Business Name): BETH ANN COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 BOSTON POST RD SUITE 16C
GUILFORD CT
06437-1369
US

IV. Provider business mailing address

2614 BOSTON POST RD SUITE 16C
GUILFORD CT
06437-1369
US

V. Phone/Fax

Practice location:
  • Phone: 203-689-5295
  • Fax: 203-689-5428
Mailing address:
  • Phone: 203-689-5295
  • Fax: 203-689-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number058158
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18970
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number047848
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number047848
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: