Healthcare Provider Details

I. General information

NPI: 1063775286
Provider Name (Legal Business Name): ABRAM COLLARD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVER ST
WAKEFIELD RI
02879-3214
US

IV. Provider business mailing address

1 RIVER ST
WAKEFIELD RI
02879-3214
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 401-767-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberO-0865
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO01134
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6813
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: