MEDICARE: DR. ROBERT P COLLINS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	843	SC
2	103TC2200X	Clinical Child & Adolescent Psychologist	5119	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164461471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT P COLLINS PHD

Provider Business Mailing Address
First Line	:	501 S SHARON AMITY RD
Second Line	:	SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2896
Country	:	US
Telephone Number	:	704-362-1555
Fax Number	:	704-362-0023

Provider Business Practice Location Address
First Line	:	501 S SHARON AMITY RD
Second Line	:	SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2896
Country	:	US
Telephone Number	:	704-362-1555
Fax Number	:	704-362-0023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	01/27/2017

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