Healthcare Provider Details

I. General information

NPI: 1578526463
Provider Name (Legal Business Name): CRAIG H. COLLISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 PENNS VALLEY RD
SPRING MILLS PA
16875
US

IV. Provider business mailing address

3631 PENNS VALLEY RD
SPRING MILLS PA
16875-8011
US

V. Phone/Fax

Practice location:
  • Phone: 814-422-8873
  • Fax: 814-422-8037
Mailing address:
  • Phone: 814-422-8873
  • Fax: 814-422-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD070449L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: