MEDICARE: COLLINS MEDICAL ASSOCIATES 2 PC

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	207X00000X	Orthopaedic Surgery Physician	018911	CT
2	207R00000X	Internal Medicine Physician

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	:	1518256452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLINS MEDICAL ASSOCIATES 2 PC

Provider Business Mailing Address
First Line	:	673 COTTAGE GROVE RD
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3033
Country	:	US
Telephone Number	:	860-242-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 ASYLUM AVE STE 3218
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-1702
Country	:	US
Telephone Number	:	860-714-5415
Fax Number	:	860-714-8861

Authorized Official
Title or Position	:	CEO- PRESIDENT
Name	:	BECAHARA BARRAK
Credential	:	MD
Telephone Number	:	860-714-5415

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/17/2018

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