Provider Demographics
NPI:1538151220
Name:COLUMBO, MICHELE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:COLUMBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 OLD LANCASTER RD STE 301
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3118
Mailing Address - Country:US
Mailing Address - Phone:610-527-2000
Mailing Address - Fax:610-525-6772
Practice Address - Street 1:830 OLD LANCASTER RD STE 301
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:610-527-2000
Practice Address - Fax:610-525-6772
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2014-10-06
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
PAMD071522L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH26596Medicare UPIN