Healthcare Provider Details

I. General information

NPI: 1265503551
Provider Name (Legal Business Name): ANDREA K COLLET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA K FRUEH MD

II. Dates (important events)

Enumeration Date: 11/10/2006
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: 740-562-6868
  • Fax: 740-205-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number35-082635
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35082635
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: