Healthcare Provider Details

I. General information

NPI: 1922144138
Provider Name (Legal Business Name): JOSEPH COLLACO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N WOLFE ST JOHNS HOPKINS PEDIATRIC PULMONARY
BALTIMORE MD
21287-0011
US

IV. Provider business mailing address

200 N WOLFE ST JOHNS HOPKINS HOSPITAL - PEDIATRIC PULMONARY
BALTIMORE MD
21287
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2035
  • Fax: 410-955-1030
Mailing address:
  • Phone: 410-955-2035
  • Fax: 410-955-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberD0060076
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: