Provider Demographics
NPI:1861405870
Name:BRUCE A. COLLEY, D.O., P.C.
Entity type:Organization
Organization Name:BRUCE A. COLLEY, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-269-5111
Mailing Address - Street 1:140 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2643
Mailing Address - Country:US
Mailing Address - Phone:610-269-5111
Mailing Address - Fax:
Practice Address - Street 1:140 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2643
Practice Address - Country:US
Practice Address - Phone:610-269-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006366L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE23146Medicare UPIN
PA042443Medicare ID - Type Unspecified