Healthcare Provider Details

I. General information

NPI: 1619190238
Provider Name (Legal Business Name): DOUGLAS R COLKITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAHONING ST
LEHIGHTON PA
18235-1246
US

IV. Provider business mailing address

800 MAHONING ST
LEHIGHTON PA
18235-1246
US

V. Phone/Fax

Practice location:
  • Phone: 484-464-4673
  • Fax:
Mailing address:
  • Phone: 484-464-4673
  • Fax: 484-464-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD026294E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085H0002X
TaxonomyHospice and Palliative Medicine (Radiology) Physician
License NumberMD026294E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: