Healthcare Provider Details

I. General information

NPI: 1508933227
Provider Name (Legal Business Name): COLIN POON M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

296 HAMMOCKS DR
ORCHARD PARK NY
14127-1683
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2433
  • Fax: 203-688-9258
Mailing address:
  • Phone: 203-500-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD60623743
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number43467
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: