Healthcare Provider Details

I. General information

NPI: 1255428819
Provider Name (Legal Business Name): JOY LYNN COLLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

102 HIGHLAND AVE SE STE 404
ROANOKE VA
24013-2232
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-2730
  • Fax:
Mailing address:
  • Phone: 540-985-9812
  • Fax: 540-985-5328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD066480L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number0101261340
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD066480L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: