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General NPI Number Information
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NPI Number | 1437149093
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Entity Type | Individual
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Provider Name | MIA M MACCOLLIN MD
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Gender | Female
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 149 13TH ST 6TH FLOOR CYN 149 6
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City | CHARLESTOWN
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State | MA
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Zip | 02129-2020
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Country | US
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Telephone | 617-726-7856
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Fax | 617-724-9620
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Provider Business Mailing Address
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Address Line | PO BOX 9142
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City | CHARLESTOWN
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State | MA
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Zip | 02129-9142
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Country | US
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Telephone | 617-724-0287
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Fax | 617-726-2894
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 73495
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 73495
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License Number State | MA
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