Healthcare Provider Details

I. General information

NPI: 1184988271
Provider Name (Legal Business Name): BETH A COLOMBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEMORIAL DR STE 212
LEOMINSTER MA
01453-2238
US

IV. Provider business mailing address

50 MEMORIAL DR STE 212
LEOMINSTER MA
01453-2238
US

V. Phone/Fax

Practice location:
  • Phone: 508-898-0055
  • Fax: 508-898-0035
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number269907
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: