Provider Demographics
NPI:1679890255
Name:COLLINS, KRISTOPHER D (MD)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:D
Last Name:COLLINS
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 1:2405 N COLUMBUS ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8189
Mailing Address - Country:US
Mailing Address - Phone:740-687-3346
Mailing Address - Fax:740-689-9736
Practice Address - Street 1:2405 N COLUMBUS ST STE 120
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8189
Practice Address - Country:US
Practice Address - Phone:406-873-3467
Practice Address - Fax:740-689-9736
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260706207X00000X
OH35.145816207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679890255Medicaid
VVL824AMedicare PIN