Healthcare Provider Details

I. General information

NPI: 1538739206
Provider Name (Legal Business Name): COLLET PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 09/12/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SUNRISE CENTER DR
ZANESVILLE OH
43701-4663
US

IV. Provider business mailing address

PO BOX 2582
ZANESVILLE OH
43702-2582
US

V. Phone/Fax

Practice location:
  • Phone: 740-816-7346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA COLLET
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 740-562-6868