MEDICARE: MRS. COLLEEN NICOLE RICE PA-C

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	363A00000X	Physician Assistant	C0005317	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C0005317	OTHER	MD	PA-C LICENSE

General Provider Information

NPI Number	:	1184047797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN NICOLE RICE PA-C

Provider Business Mailing Address
First Line	:	10800 WILL PAINTER DR
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5124
Country	:	US
Telephone Number	:	443-243-3747
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 OSLER DR STE 104
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21204-7737
Country	:	US
Telephone Number	:	410-337-8888
Fax Number	:	410-823-4833

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

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	03/08/2019

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