Healthcare Provider Details

I. General information

NPI: 1073569042
Provider Name (Legal Business Name): BARBARA A COLOSIMO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 GRAYSTONE PL SE
CONOVER NC
28613-8200
US

IV. Provider business mailing address

1161 DAISY LN
HICKORY NC
28602-9539
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-1118
  • Fax: 828-328-1119
Mailing address:
  • Phone: 828-328-1118
  • Fax: 828-328-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME71072
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number207537
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: