MEDICARE: CRYSTAL M COLBY 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	363AM0700X	Medical Physician Assistant	0611	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	RE5088	OTHER	NH	MEDICARE B GROUP

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346304888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL M COLBY PA-C

Provider Business Mailing Address
First Line	:	220 COTTAGE ST
Second Line	:
City	:	LITTLETON
State	:	NH
Zip	:	03561-4101
Country	:	US
Telephone Number	:	603-444-7070
Fax Number	:	603-444-4075

Provider Business Practice Location Address
First Line	:	220 COTTAGE ST
Second Line	:
City	:	LITTLETON
State	:	NH
Zip	:	03561-4101
Country	:	US
Telephone Number	:	603-444-7070
Fax Number	:	603-444-4075

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/16/2008

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Directions to “ CRYSTAL M COLBY PA-C” Practice Location

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