Healthcare Provider Details

I. General information

NPI: 1275767915
Provider Name (Legal Business Name): MOLLY ELIZABETH COLLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE SUITE 701
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-3544
  • Fax: 215-214-3901
Mailing address:
  • Phone: 215-728-3544
  • Fax: 215-214-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT194926
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT194926
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD445411
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: