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General NPI Number Information
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NPI Number | 1700839859
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Entity Type | Individual
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Provider Name | JUDITH YEN LIN COLCLOUGH MD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 6905 KNIGHTDALE BLVD STE 106
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City | KNIGHTDALE
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State | NC
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Zip | 27545-6506
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Country | US
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Telephone | 919-261-8760
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Fax | 919-261-8765
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Provider Business Mailing Address
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Address Line | 2000 PERIMETER PARK DR STE 200
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City | MORRISVILLE
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State | NC
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Zip | 27560-8442
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3811
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 237887
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200401649
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License Number State | NC
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