Provider Demographics
NPI:1528247145
Name:COLORADO, MARY CATHY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHY
Last Name:COLORADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-1305
Mailing Address - Country:US
Mailing Address - Phone:256-586-0555
Mailing Address - Fax:
Practice Address - Street 1:319 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-1305
Practice Address - Country:US
Practice Address - Phone:256-586-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist