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General NPI Number Information
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NPI Number | 1528164704
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Entity Type | Individual
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Provider Name | JACOB FREDRICK COLLEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 5255 LOUGHBORO RD NW
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City | WASHINGTON
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State | DC
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Zip | 20016-2633
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Country | US
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Telephone | 410-955-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE
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City | BALTIMORE
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 240-439-8812
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Fax |
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | D79963
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD500002488
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License Number State | DC
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