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General NPI Number Information
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NPI Number | 1356306948
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Entity Type | Individual
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Provider Name | MARCIA L COLLINS MD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3533 SOUTHERN BLVD STE 4600
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City | KETTERING
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State | OH
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Zip | 45429-1273
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Country | US
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Telephone | 937-296-0167
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Fax | 937-297-2330
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Provider Business Mailing Address
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Address Line | 3533 SOUTHERN BLVD STE 4600
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City | KETTERING
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State | OH
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Zip | 45429-1273
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Country | US
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Telephone | 937-296-0167
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Fax | 937-297-2330
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 35033205
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License Number State | OH
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