Healthcare Provider Details

I. General information

NPI: 1619092533
Provider Name (Legal Business Name): HEATHER P COLLUPY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N MAIN ST
ATTLEBORO MA
02703-1752
US

IV. Provider business mailing address

72 CANNON BALL RD
SHARON MA
02067-2857
US

V. Phone/Fax

Practice location:
  • Phone: 508-223-1822
  • Fax:
Mailing address:
  • Phone: 508-223-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number150272
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: