Healthcare Provider Details

I. General information

NPI: 1912910720
Provider Name (Legal Business Name): LAUREN G. COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST SUITE 301
PHILADELPHIA PA
19107-4414
US

IV. Provider business mailing address

833 CHESTNUT ST SUITE 301
PHILADELPHIA PA
19107-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7190
  • Fax: 215-923-9186
Mailing address:
  • Phone: 215-955-7190
  • Fax: 215-923-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD425608
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD425608
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: