Healthcare Provider Details

I. General information

NPI: 1336382712
Provider Name (Legal Business Name): MICHAEL TERRENCE COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CONVENT DR BUILDING 30, ROOM 228, MSC 4320
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

30 CONVENT DR BUILDING 30, ROOM 228, MSC 4320
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-4913
  • Fax: 301-402-0824
Mailing address:
  • Phone: 301-496-4913
  • Fax: 301-402-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0045237
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: