Provider Demographics
NPI:1144451253
Name:BETH A COLLINS MD, P.C.
Entity type:Organization
Organization Name:BETH A COLLINS MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-374-2654
Mailing Address - Street 1:2614 BOSTON POST RD
Mailing Address - Street 2:SUITE 16C
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1369
Mailing Address - Country:US
Mailing Address - Phone:203-689-5295
Mailing Address - Fax:203-689-5428
Practice Address - Street 1:2614 BOSTON POST RD
Practice Address - Street 2:SUITE 16C
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1369
Practice Address - Country:US
Practice Address - Phone:203-689-5295
Practice Address - Fax:203-689-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0478482086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty